Provider Demographics
NPI:1881922672
Name:ST. ANN CORPORATION DBA BRIGHTSTAR OF NORTHERN MICHIGAN
Entity type:Organization
Organization Name:ST. ANN CORPORATION DBA BRIGHTSTAR OF NORTHERN MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ZIMMERMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:231-929-7827
Mailing Address - Street 1:525 W 14TH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4060
Mailing Address - Country:US
Mailing Address - Phone:231-929-7827
Mailing Address - Fax:231-929-7829
Practice Address - Street 1:525 W 14TH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4060
Practice Address - Country:US
Practice Address - Phone:231-929-7827
Practice Address - Fax:231-929-7829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health