Timberline Lodge Inc. Afc

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

AM790009691 Issued in MI

Legal business name

TIMBERLINE LODGE INC. AFC

Practice address

3771 Colwood Rd
Caro, MI 48723-9732

Phone

(989) 673-4990

Fax

(989) 673-4991

NPI assigned

Nov 26, 2013

Organization subpart

No

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

Authorized official

Name

Kristine Diegel

Title

Administrator

Phone

(989) 673-4990

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1385424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385424000000",
    "number": "1164852240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3771 COLWOOD RD",
            "city": "CARO",
            "state": "MI",
            "postal_code": "487239732",
            "telephone_number": "989-673-4990",
            "fax_number": "989-673-4991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3771 COLWOOD RD",
            "city": "CARO",
            "state": "MI",
            "postal_code": "487239732",
            "telephone_number": "989-673-4990",
            "fax_number": "989-673-4991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMBERLINE LODGE INC. AFC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-26",
        "last_updated": "2013-11-26",
        "status": "A",
        "authorized_official_last_name": "DIEGEL",
        "authorized_official_first_name": "KRISTINE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "989-673-4990"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MI",
            "license": "AM790009691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "AM790009691",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ednan Basit Syed
• Corinn Stacey Szcygiel, OTRL
• Vanessa Taylor, MSW, LMSW
• TDS Pharmacy Inc (Sheldon Medical Supply)
• Etta Marie Thane, ABOC
• Kenneth Frederick Tiseo, DDS
• Devashish Tiwari
• TM Chiropractic, LLC
• Kaitlyn Tobin
• Courtney Lynn Topp, FNP-BC

• Adult Care Home Facility in Caro, MI
• Providers in Caro, 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 26, 2013; 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.