Active NPI
Houghton County Medical Care Facility
Doing business as Canal View Houghton County
- Skilled Nursing Facility
- Hancock, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 318510
- Legal business name
- HOUGHTON COUNTY MEDICAL CARE FACILITY
- Doing business as
- Canal View Houghton County
- Practice address
- 1100 W Quincy St
Hancock, MI 49930-1404 - Phone
- (906) 482-5050
- Fax
- (906) 482-4609
- NPI assigned
- Aug 24, 2005
- Last updated
- Jun 25, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Denise M Brisebois, SENIOR BILLING SPECI
- Title
- Senior Billing Specialist
- Phone
- (906) 483-2153
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 318510 | MI | Primary |
Addresses
Primary practice location
1100 W Quincy St
Hancock, MI 49930-1404
Mailing address
1100 W Quincy St
Hancock, MI 49930-1404
Phone (906) 482-5050
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2085034 | Medicaid | MI | |
| 09620 | Other | MI | BLUE CROSS |
Other names 1
- Canal View Houghton County
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120114000058 | MI | Part A Provider - Skilled Nursing Facility | 8820265846 | Practice locations: Hancock, MI |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1083607139. Details of each certification follow.
Skilled nursing facility certification: CCN 235031
- Legal name
- HOUGHTON COUNTY MEDICAL CARE FACILITY
- Doing business as
- CANAL VIEW HOUGHTON COUNTY
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1967
- Last certification
- Nov 20, 2024
- Beds
- 197
- Ownership / control type
- City/County
- Organization structure
- Other
- Enrollment address
- 1100 W Quincy St
Hancock, MI 49930-1404 - Nursing home name
- CANAL VIEW - HOUGHTON COUNTY
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Canal View - Houghton County
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Government - City/county
- Certified
- Jan 1, 1967
- Medicare certification status
- Active
- Certified beds
- 197
- Penalties (3 years)
- 3
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D0724364 | Canal View-Houghton County | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 8
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Kara Destrampe | Operational/Managerial Control | Jan 15, 2025 | |
| Edward Jenich | Managing Control - Governing Body | Jan 1, 2013 | |
| Adam Laplander | Operational/Managerial Control | Sep 1, 2023 | |
| Adp of the SNF | Mar 24, 2025 | ||
| Christy Hilgers | Managing Control - Governing Body | Nov 1, 2010 | |
| James Tervo | Managing Control - Governing Body | Jan 1, 2020 | |
| Houghton County Medical Care Facility | 5% Or Greater Direct Ownership Interest | Jan 1, 1968 | 100% |
| Operational/Managerial Control | Aug 6, 1996 | 100% | |
| Ashley Kuru | Operational/Managerial Control | Jan 15, 2025 | |
| Terry Kinzel | Operational/Managerial Control | Jan 24, 2025 | |
| Adp of the SNF | Jan 24, 2025 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Hancock, MI
- NPI 1023048477
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Geriatric Medicine (Internal Medicine) Physician
- Houghton, MI
- NPI 1871054395
-
- Family Medicine Physician
- Hancock, MI
- NPI 1184886137
-
- Family Medicine Physician
- Laurium, MI
- NPI 1922114271
-
- Internal Medicine Physician
- Hancock, MI
- NPI 1023048477
-
- Family Medicine Physician
- Laurium, MI
- NPI 1184787772
-
- Family Medicine Physician
- Laurium, MI
- NPI 1497131452
Affiliated clinicians 6
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Internal Medicine) Physician
- Houghton, MI
- NPI 1871054395
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124841600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1561420800000",
"number": "1083607139",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 W QUINCY ST",
"city": "HANCOCK",
"state": "MI",
"postal_code": "499301404",
"telephone_number": "906-482-5050",
"fax_number": "906-482-4609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 W QUINCY ST",
"city": "HANCOCK",
"state": "MI",
"postal_code": "499301404",
"telephone_number": "906-482-5050",
"fax_number": "906-482-4609"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOUGHTON COUNTY MEDICAL CARE FACILITY",
"organizational_subpart": "NO",
"enumeration_date": "2005-08-24",
"last_updated": "2019-06-25",
"status": "A",
"authorized_official_last_name": "BRISEBOIS",
"authorized_official_first_name": "DENISE",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "SENIOR BILLING SPECIALIST",
"authorized_official_telephone_number": "906-483-2153",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "SENIOR BILLING SPECI"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "MI",
"license": "318510",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2085034",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "09620",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Canal View Houghton County",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Hancock, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.