Active NPI
Carrie Lynn Dextrom
- Adult Companion
- Manton, MI
National Provider Identifier
1437626256
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Companion
- Practice address
- 9200 W Walker Rd
Manton, MI 49663-9315 - Phone
- (231) 878-8352
- NPI assigned
- Oct 30, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Companion | 372600000X | Primary |
Addresses
Primary practice location
9200 W Walker Rd
Manton, MI 49663-9315
Mailing address
9200 W Walker Rd
Manton, MI 49663-9315
Phone (231) 878-3914
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Magnolia Care Afc Home LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Foster Care Agency
- Manton, MI
- NPI 1184191918
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540857600000",
"number": "1437626256",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9200 W WALKER RD",
"city": "MANTON",
"state": "MI",
"postal_code": "496639315",
"telephone_number": "231-878-3914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9200 W WALKER RD",
"city": "MANTON",
"state": "MI",
"postal_code": "496639315",
"telephone_number": "231-878-8352"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEXTROM",
"first_name": "CARRIE",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-30",
"last_updated": "2018-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "372600000X",
"taxonomy_group": "",
"desc": "Adult Companion",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.