1053342220 NPI number — HAVENWYCK HOSPITAL INC

Table of content: (NPI 1053342220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053342220 NPI number — HAVENWYCK HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAVENWYCK HOSPITAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053342220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1525 UNIVERSITY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48326-2673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-373-9200
Provider Business Mailing Address Fax Number:
248-373-4113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1525 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48326-2673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-373-9200
Provider Business Practice Location Address Fax Number:
248-373-4113
Provider Enumeration Date:
07/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FILTON
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
SRVP CFO
Authorized Official Telephone Number:
610-768-3300

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , with the licence number:  H-075/2006 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 170528921 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00106 . This is a "BLUE CROSS BLUE SHIELD OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".