1376524090 NPI number — BRONSON AT HOME

Table of content: (NPI 1376524090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376524090 NPI number — BRONSON AT HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRONSON AT HOME
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:
6
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:
1376524090
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 JOHN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49007-5295
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-341-7806
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4625 BECKLEY RD
Provider Second Line Business Practice Location Address:
BLDG 200, STE A
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49015-7956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-241-4663
Provider Business Practice Location Address Fax Number:
269-660-3650
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EAST
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, BRONSON AT HOME
Authorized Official Telephone Number:
269-341-7806

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3332416 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0E123 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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