Douglas Mi Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

DOUGLAS MI OPCO LLC

Practice address

243 Wiley Rd
Douglas, MI 49406-5169

Phone

(269) 857-2141

NPI assigned

Jun 11, 2020

Last updated

Jun 11, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Batya Gorelick

Title

VP of Admin Services

Phone

(269) 857-2141

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Practitioners 3

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.

• William H Dukes, MD

  • Family Medicine Physician
  • Grand Rapids, MI
  • NPI 1154322113
  NPD (past)
• Robert N Israel, M.D.

  • Family Medicine Physician
  • Jackson, MI
  • NPI 1083688261
  NPD (past)
• Nicholas Maximillian Kielhorn, M.D.

  • Family Medicine Physician
  • Jackson, MI
  • NPI 1821240128
  NPD (past)

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

{
    "created_epoch": "1591833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591833600000",
    "number": "1922623248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 SYLVAN AVE STE 240",
            "city": "ENGLEWOOD CLIFFS",
            "state": "NJ",
            "postal_code": "076322700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 WILEY RD",
            "city": "DOUGLAS",
            "state": "MI",
            "postal_code": "494065169",
            "telephone_number": "269-857-2141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS MI OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-11",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A",
        "authorized_official_last_name": "GORELICK",
        "authorized_official_first_name": "BATYA",
        "authorized_official_title_or_position": "VP OF ADMIN SERVICES",
        "authorized_official_telephone_number": "269-857-2141"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelley Ann Defouw, LPT
• Dellavecchia Dental Services, P.C.
• Tracey Jean Dellavecchia, D.D.S.
• Douglas Cove Mi Opco LLC
• Douglas Investments & Associates, LLC (Grace of Douglas)
• Focus Point Behavioral Health, PLLC
• Cassandra Goerge
• Raechel Hardin, LPC
• Richard W Householder, PTA
• K Enriquez Counseling PLLC.

• Skilled Nursing Facility in Douglas, MI
• Providers in Douglas, MI by specialty
• Skilled Nursing Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.