NPIMap

Organization Active NPI

State of Michigan

  • Skilled Nursing Facility
  • Marquette, MI
National Provider Identifier
1366912669
Registry record updated Nov 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
STATE OF MICHIGAN
Practice address
425 Fisher St
Marquette, MI 49855-4521
Phone
(906) 226-3576
Fax
(906) 226-2380
NPI assigned
Nov 29, 2018
Organization subpart
Yes
Parent organization
STATE OF MICHIGANAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 29, 2018

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

Authorized official

Name
Mr. Ryan Engle
Title
Administrator
Phone
(906) 226-3576

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

425 Fisher St
Marquette, MI 49855-4521

Mailing address

425 Fisher St
Marquette, MI 49855-4521
Phone (906) 226-3576

Other names 1

  • D.J. Jacobetti Home for Veterans Doing business as

National Provider Directory

National Provider Directory
Tax ID family
State of Mi Management15 organizations share this tax ID, including this one
Part of
State of Mi Management

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1543449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543449600000",
    "number": "1366912669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 FISHER ST",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498554521",
            "telephone_number": "906-226-3576",
            "fax_number": "906-226-2380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 FISHER ST",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498554521",
            "telephone_number": "906-226-3576",
            "fax_number": "906-226-2380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MICHIGAN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF MICHIGAN",
        "enumeration_date": "2018-11-29",
        "last_updated": "2018-11-29",
        "status": "A",
        "authorized_official_last_name": "ENGLE",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "906-226-3576",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "D.J. Jacobetti Home for Veterans",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marquette, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 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.