Active NPI
Donna Sissell
- Adult Care Home Facility
- Sand Lake, MI
National Provider Identifier
1962983866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Care Home Facility
- License
- AL410001178A
- Practice address
- 8180 19 Mile Rd
Sand Lake, MI 49343-9455 - Phone
- (616) 696-2304
- NPI assigned
- Aug 28, 2018
- Last updated
- Aug 28, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 Care Home Facility | 311ZA0620X | AL410001178A | MI | Primary |
Addresses
Primary practice location
8180 19 Mile Rd
Sand Lake, MI 49343-9455
Mailing address
8180 19 Mile Rd
Sand Lake, MI 49343-9455
Phone (616) 696-2304
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL410001178A | MI | MD | Adult Care Home Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535414400000",
"number": "1962983866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8180 19 MILE RD",
"city": "SAND LAKE",
"state": "MI",
"postal_code": "493439455",
"telephone_number": "616-696-2304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8180 19 MILE RD",
"city": "SAND LAKE",
"state": "MI",
"postal_code": "493439455",
"telephone_number": "616-696-2304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SISSELL",
"first_name": "DONNA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-28",
"last_updated": "2018-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "311ZA0620X",
"taxonomy_group": "",
"desc": "Custodial Care Facility, Adult Care Home",
"state": "MI",
"license": "AL410001178A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sand Lake, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.