Convalcare Corporation

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

334070 Issued in MI

Legal business name

CONVALCARE CORPORATION

Practice address

406 W Main St
Stockbridge, MI 49285-9719

Phone

(517) 851-7700

Fax

(517) 851-8862

NPI assigned

Jun 21, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Paul E Himelhoch, L.N.H.

Title

Administrator

Phone

(517) 851-7700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Stockbridge Country Manor Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043216518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 W MAIN ST",
            "city": "STOCKBRIDGE",
            "state": "MI",
            "postal_code": "492859719",
            "telephone_number": "517-851-7700",
            "fax_number": "517-851-8862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 W MAIN ST",
            "city": "STOCKBRIDGE",
            "state": "MI",
            "postal_code": "492859719",
            "telephone_number": "517-851-7700",
            "fax_number": "517-851-8862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONVALCARE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HIMELHOCH",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "517-851-7700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.N.H."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "334070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4579230",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stockbridge Country Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gary Adiska
• Heather Michelle Adiska, D.D.S.
• Aaron Edward Burke
• David C. Bust
• Chelsea Professional Services
• Dahl Dental of Stockbridge PLLC
• Jouraish Mohammed Daoud, DMD
• Trevor Dase
• Paul Herman Dobos, DDS
• Katlin Dunford

• Skilled Nursing Facility in Stockbridge, MI
• Providers in Stockbridge, MI by specialty
• Skilled Nursing Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.