Healthcare Provider Details

I. General information

NPI: 1730146630
Provider Name (Legal Business Name): HARBOR BEACH COMMUNITY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S 1ST ST
HARBOR BEACH MI
48441-1236
US

IV. Provider business mailing address

210 S 1ST ST
HARBOR BEACH MI
48441-1236
US

V. Phone/Fax

Practice location:
  • Phone: 989-479-3201
  • Fax: 989-479-5002
Mailing address:
  • Phone: 989-479-3201
  • Fax: 989-479-5002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number320040
License Number StateMI

VIII. Authorized Official

Name: JILL WEHNER
Title or Position: VP/COO
Credential:
Phone: 989-479-3201