Healthcare Provider Details

I. General information

NPI: 1538167630
Provider Name (Legal Business Name): ATRIUM HILLCREST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 FRIANT ST
GRAND HAVEN MI
49417-2311
US

IV. Provider business mailing address

415 FRIANT ST
GRAND HAVEN MI
49417-2311
US

V. Phone/Fax

Practice location:
  • Phone: 616-842-4120
  • Fax: 616-842-8742
Mailing address:
  • Phone: 616-842-4120
  • Fax: 616-842-8742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number70-4090
License Number StateMI

VIII. Authorized Official

Name: JAMES FERKANY
Title or Position: SECRETARY
Credential:
Phone: 614-454-6048