Healthcare Provider Details

I. General information

NPI: 1174721740
Provider Name (Legal Business Name): SAINT JOSEPH LIVINGSTON HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GENOA BUSINESS PARK DR STE 180
BRIGHTON MI
48114-7374
US

IV. Provider business mailing address

620 BYRON RD
HOWELL MI
48843-1002
US

V. Phone/Fax

Practice location:
  • Phone: 734-786-2300
  • Fax:
Mailing address:
  • Phone: 517-545-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number470079
License Number StateMI

VIII. Authorized Official

Name: MICHAEL PAUL GUSHO
Title or Position: REGIONAL CFO
Credential:
Phone: 231-672-3886