Healthcare Provider Details

I. General information

NPI: 1104459627
Provider Name (Legal Business Name): BRONSON LAKEVIEW HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 11/27/2023
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 RAILROAD ST
BANGOR MI
49013-1490
US

IV. Provider business mailing address

301 JOHN ST # 42
KALAMAZOO MI
49007-5295
US

V. Phone/Fax

Practice location:
  • Phone: 269-427-5811
  • Fax: 269-427-6107
Mailing address:
  • Phone: 269-341-8536
  • Fax: 269-341-8913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REBECCA EAST
Title or Position: CFO
Credential:
Phone: 269-341-6000