Rose Marie Bouck

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

AF410395782 Issued in MI

Practice address

12700 Lincoln Lake Ave
Gowen, MI 49326

Phone

(231) 580-4533

Fax

(616) 712-6002

NPI assigned

Nov 8, 2018

Last updated

Nov 8, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northern Pathways

  • Adult Care Home Facility
  • Gowen, MI
  • NPI 1366110314
  NPD (past)

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

{
    "created_epoch": "1541635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541635200000",
    "number": "1073081907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12700 LINCOLN LAKE AVE",
            "city": "GOWEN",
            "state": "MI",
            "postal_code": "493269403",
            "telephone_number": "231-580-4533",
            "fax_number": "616-712-6002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12700 LINCOLN LAKE AVE",
            "city": "GOWEN",
            "state": "MI",
            "postal_code": "49326",
            "telephone_number": "231-580-4533",
            "fax_number": "616-712-6002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCK",
        "first_name": "ROSE",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-08",
        "last_updated": "2018-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MI",
            "license": "AF410395782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melinda Justine Bagaga, LICENSED MIDWIFE
• Brandi Ball
• Beauty From Birth
• Tia Nicole Christensen
• Kathi June Grifhorst, DC
• Amanda D Hansing, LPC
• Katherine E Jourden
• Hamanni Lee

• Adult Care Home Facility in Gowen, MI
• Providers in Gowen, MI by specialty
• Adult Care Home Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; 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.