Promedica of Adrian Mi, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PROMEDICA OF ADRIAN MI, LLC

Practice address

581 Kimole LN
Adrian, MI 49221-1492

Phone

(517) 265-0690

Fax

(517) 266-0704

NPI assigned

Jan 3, 2019

Organization subpart

No

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

Authorized official

Name

Martin D Allen

Title

Director

Phone

(419) 252-5734

Specialties & licenses 1

Addresses

Other names 1

• ProMedica Charlotte Stephenson Manor Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1546473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546473600000",
    "number": "1285107151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SUMMIT ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436042615",
            "telephone_number": "419-252-5500",
            "fax_number": "800-480-3780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "581 KIMOLE LN",
            "city": "ADRIAN",
            "state": "MI",
            "postal_code": "492211492",
            "telephone_number": "517-265-0690",
            "fax_number": "517-266-0704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROMEDICA OF ADRIAN MI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-03",
        "last_updated": "2019-01-03",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "419-252-5734"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProMedica Charlotte Stephenson Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tesha Proffitt
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• Promedica Northwest Ohio Cardiology Consultants, LLC
• Whitney Alysse Puckey, LLPC
• Pure Psychiatry of Michigan PLLC
• Vanessa Putnam, LMT
• Quality Companions Private Care LLC
• R3 Counseling, LLC

• Assisted Living Facility in Adrian, MI
• Providers in Adrian, MI by specialty
• Assisted Living Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.

Verify at the official NPI Registry.