PINE RIDGE: A REHABILITATION & NURSING CENTER (MERCY MEMORIAL HEALTH SERVICES INC) NPI 1003802596

Skilled Nursing Facility in Stevensville, MI

Organization Skilled Nursing Facility

About PINE RIDGE: A REHABILITATION & NURSING CENTER (MERCY MEMORIAL HEALTH SERVICES INC)

Pine Ridge: A Rehabilitation & Nursing Center (mercy Memorial Health Services Inc) is a provider established in Stevensville, Michigan specializing in skilled nursing facility. The NPI number of Pine Ridge: A Rehabilitation & Nursing Center (mercy Memorial Health Services Inc) is 1003802596 and was assigned on September 2005. The practitioner's primary taxonomy code is 314000000X with license number 114130 (MI). The provider is registered as an organization and their NPI record was last updated June 2019. The provider's is doing business as Pine Ridge: A Rehabilitation & Nursing Center.
The authorized official of this NPI record is Mr. Timothy Calhoun (Cfo)

NPI

1003802596

Provider NamePINE RIDGE: A REHABILITATION & NURSING CENTER (MERCY MEMORIAL HEALTH SERVICES INC)
Provider Location Address4368 CLEVELAND AVE STEVENSVILLE, MI 49127
Provider Mailing AddressPO BOX 410 SAINT JOSEPH, MI 49085
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NamePINE RIDGE: A REHABILITATION & NURSING CENTER
Other Name TypeDoing Business As (3)
Enumeration Date09-21-2005
Last Update Date06-10-2019

Primary Taxonomy

Taxonomy Code314000000X
ClassificationSkilled Nursing Facility
TypeNursing & Custodial Care Facilities
License No.114130
License StateMI
Taxonomy Description(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.

Business Address

PINE RIDGE: A REHABILITATION & NURSING CENTER (MERCY MEMORIAL HEALTH SERVICES INC)
4368 CLEVELAND AVE
STEVENSVILLE, MI
ZIP 49127
Phone: (269) 983-6501
Fax: (269) 983-2237

Get Directions

Mailing Address

PINE RIDGE: A REHABILITATION & NURSING CENTER (MERCY MEMORIAL HEALTH SERVICES INC)
PO BOX 410
SAINT JOSEPH, MI
ZIP 49085
Phone: (269) 983-6501
Fax: (269) 983-2237

Authorized Official

Authorized Official NameMR. TIMOTHY CALHOUN
Authorized Official TitleCFO
Authorized Official Phone(269) 983-8304

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
2783575MEDICAID (05)MI

Other Providers at the same location


The following 5 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1295984359 MICHELE Y. HURSH NP
Individual
Nurse Practitioner4368 CLEVELAND AVE
STEVENSVILLE, MI 49127
(270) 983-6501
1598266173 STEPHANIE BLOMMEL OTR/L
Individual
Occupational Therapist4368 CLEVELAND AVE
STEVENSVILLE, MI 49127
(269) 983-6501
1689175218 RHODA MSACHI PTA
Individual
Physical Therapy Assistant4368 CLEVELAND AVE
STEVENSVILLE, MI 49127
(269) 983-6501
1699276386 KRISTEN KAYE BACHMAN COTA
Individual
Occupational Therapy Assistant (Low Vision)4368 CLEVELAND AVE
STEVENSVILLE, MI 49127
(269) 983-6501
1780186387 JOEL DAVID DURAN PT, DPT
Individual
Physical Therapist4368 CLEVELAND AVE
STEVENSVILLE, MI 49127
(269) 983-6501

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.

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