Healthcare Provider Details

I. General information

NPI: 1285651760
Provider Name (Legal Business Name): LAKELAND SPECIALTY HOSPITAL AT BERRIEN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/03/2008
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

PO BOX 800
SAINT JOSEPH MI
49085-0800
US

V. Phone/Fax

Practice location:
  • Phone: 269-473-3003
  • Fax: 269-473-3010
Mailing address:
  • Phone: 269-428-2574
  • Fax: 269-428-0490

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: MR. TIM CALHOUN
Title or Position: CFO/VP OF FINANCE
Credential:
Phone: 269-983-8398