1194767186 NPI number — MERCY HEALTH PARTNERS

Table of content: (NPI 1194767186)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194767186 NPI number — MERCY HEALTH PARTNERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HEALTH PARTNERS
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:
HACKLEY BEHAVIORAL HEALTH SERVICES
Provider Other Organization Name Type Code:
3
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:
1194767186
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1847
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSKEGON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49443-1847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-727-4444
Provider Business Mailing Address Fax Number:
231-728-4789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 CLINTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49442-5502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-728-4950
Provider Business Practice Location Address Fax Number:
231-728-4036
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOHMAN
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
REGION DIR PHYSICIAN REVENUE CYCLE
Authorized Official Telephone Number:
231-727-4499

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0P15090 . This is a "GROUP PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0F16394 . This is a "GROUP PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0N85740 . This is a "GROUP PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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