Healthcare Provider Details

I. General information

NPI: 1033105549
Provider Name (Legal Business Name): LAKELAND SPECIALTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6418 DEANS HILL RD
BERRIEN CENTER MI
49102-9750
US

IV. Provider business mailing address

6418 DEANS HILL RD
BERRIEN CENTER MI
49102-9750
US

V. Phone/Fax

Practice location:
  • Phone: 269-473-3003
  • Fax:
Mailing address:
  • Phone: 269-473-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number113010
License Number StateMI

VIII. Authorized Official

Name: TERRY STANARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 269-473-3003