Provider Demographics
NPI:1730186891
Name:PINECREST MEDICAL CARE FACILITY
Entity type:Organization
Organization Name:PINECREST MEDICAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MAPES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-497-5244
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:POWERS
Mailing Address - State:MI
Mailing Address - Zip Code:49874-0603
Mailing Address - Country:US
Mailing Address - Phone:906-497-5244
Mailing Address - Fax:906-497-5005
Practice Address - Street 1:N15995 MAIN ST
Practice Address - Street 2:
Practice Address - City:POWERS
Practice Address - State:MI
Practice Address - Zip Code:49874-9608
Practice Address - Country:US
Practice Address - Phone:906-497-5244
Practice Address - Fax:906-497-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR0401X
MI558510314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30413OtherBCBSM PROVIDER NUMBER
MI09623OtherBCBSM PROVIDER ID NUMBER
MI61 2085277Medicaid
MI64 2085277Medicaid
MI09623OtherBCBSM PROVIDER ID NUMBER