NPIMap

Organization Active NPI

Packard Specialized Residential

  • Assisted Living Facility
  • Burton, MI
National Provider Identifier
1225633035
Registry record updated Dec 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
PACKARD SPECIALIZED RESIDENTIAL
Practice address
1173 S Packard Ave
Burton, MI 48509-2311
Phone
(810) 288-2226
Fax
(810) 462-1093
NPI assigned
Dec 1, 2020
Last updated
Dec 1, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2020

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

Authorized official

Name
Mr. Mitchell F Naegele
Title
Administrator
Phone
(810) 288-2226

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

1173 S Packard Ave
Burton, MI 48509-2311

Mailing address

1173 S Packard Ave
Burton, MI 48509-2311
Phone (810) 288-2226

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1606780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606780800000",
    "number": "1225633035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1173 S PACKARD AVE",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485092311",
            "telephone_number": "810-288-2226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1173 S PACKARD AVE",
            "city": "BURTON",
            "state": "MI",
            "postal_code": "485092311",
            "telephone_number": "810-288-2226",
            "fax_number": "810-462-1093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACKARD SPECIALIZED RESIDENTIAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-01",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A",
        "authorized_official_last_name": "NAEGELE",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "810-288-2226",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.