Provider Demographics
NPI:1184621658
Name:DURAND CONVALESCENT CENTER
Entity type:Organization
Organization Name:DURAND CONVALESCENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LARUE
Authorized Official - Suffix:
Authorized Official - Credentials:VICE PRESIDENT
Authorized Official - Phone:989-288-3166
Mailing Address - Street 1:8750 E. MONROE RD.
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:MI
Mailing Address - Zip Code:48429-0197
Mailing Address - Country:US
Mailing Address - Phone:989-288-3166
Mailing Address - Fax:989-288-6622
Practice Address - Street 1:8750 E. MONROE RD.
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:MI
Practice Address - Zip Code:48429-0197
Practice Address - Country:US
Practice Address - Phone:989-288-3166
Practice Address - Fax:989-288-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2150849Medicaid
MI2150849Medicaid