1700260916 NPI number — TRINITY HEALTH-MICHIGAN

Table of content: (NPI 1700260916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700260916 NPI number — TRINITY HEALTH-MICHIGAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY HEALTH-MICHIGAN
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:
1700260916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6050 NORTHLAND DR NE
Provider Second Line Business Mailing Address:
SUITE 1107
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49341-9256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-685-7990
Provider Business Mailing Address Fax Number:
616-685-7998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6050 NORTHLAND DR NE
Provider Second Line Business Practice Location Address:
SUITE 1107
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49341-9256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-685-7990
Provider Business Practice Location Address Fax Number:
616-685-7998
Provider Enumeration Date:
07/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
CASALOU
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
734-712-3792

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  5301010706 , 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: 1700260916 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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