Creekside Manor

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

AM540070004 Issued in MI

Legal business name

CREEKSIDE MANOR

Practice address

17460 12 Mile Rd
Big Rapids, MI 49307-9554

Phone

(231) 796-6131

NPI assigned

Feb 7, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Michael Dean Chaffee

Title

Owner

Phone

(231) 796-6131

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1486425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486425600000",
    "number": "1073051264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17460 12 MILE RD",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493079554",
            "telephone_number": "231-796-6131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17460 12 MILE RD",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493079554",
            "telephone_number": "231-796-6131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-07",
        "last_updated": "2017-02-07",
        "status": "A",
        "authorized_official_last_name": "CHAFFEE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-796-6131",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MI",
            "license": "AM540070004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maia Elizabeth Conlon, PA-C
• Jerome Arthur Conrad, M.D.
• Nichole Cooley
• County of Mecosta
• Inez Crandell
• Ralph P Crew, D.O.
• Jonathan Robert Crimm, PT, DPT
• Bonnie Sue Cripe, PHD LMSW ACSW DAPA
• Shelly Lynn Cripps
• Jill R Crosby, PT

• Exclusive Provider Organization in Big Rapids, MI
• Providers in Big Rapids, MI by specialty
• Exclusive Provider Organization in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2017; 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.