1528064466 NPI number — LEELANAU MEMORIAL HEALTH CENTER

Table of content: (NPI 1528064466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528064466 NPI number — LEELANAU MEMORIAL HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEELANAU MEMORIAL HEALTH CENTER
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:
1528064466
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORHTPORT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49670
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-935-6181
Provider Business Mailing Address Fax Number:
231-935-7952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHPORT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-935-6181
Provider Business Practice Location Address Fax Number:
231-935-7952
Provider Enumeration Date:
06/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GARTHE
Authorized Official First Name:
KATHRINE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
231-935-6181

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 282N00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 282NC0060X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 313M00000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 314000000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 2000411 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15167 . This is a "BLUE CROSS LTC PRIMARY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5171092 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00167 . This is a "BLUE CROSS FACILITY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1562631 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09759 . This is a "BLUE CROSS LTC SECONDARY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com