1154754034 NPI number — NORTHCREST OPERATING CO.,INC.

Table of content: (NPI 1154754034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154754034 NPI number — NORTHCREST OPERATING CO.,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHCREST OPERATING CO.,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:
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:
1154754034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 HAKES DR
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
NORTON SHORES
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49441-5574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-799-6882
Provider Business Mailing Address Fax Number:
231-799-0250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2650 RUDDIMAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH MUSKEGON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49445-3260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-744-2447
Provider Business Practice Location Address Fax Number:
231-744-2448
Provider Enumeration Date:
08/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
REESE
Authorized Official First Name:
JASON
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT & CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
614-416-0600

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AH610236856 , 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: AH610236856 . This is a "STATE OF MICHIGAN DEPARTMENT OF HUMAN SERVICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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