Healthcare Provider Details

I. General information

NPI: 1023001146
Provider Name (Legal Business Name): PENNOCK HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 W GREEN ST
HASTINGS MI
49058-1710
US

IV. Provider business mailing address

1009 W GREEN ST
HASTINGS MI
49058-1710
US

V. Phone/Fax

Practice location:
  • Phone: 269-945-1212
  • Fax: 269-948-3117
Mailing address:
  • Phone: 269-945-1212
  • Fax: 269-948-3117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: SHERYL L LEWIS-BLAKE
Title or Position: PRESIDENT
Credential:
Phone: 269-948-3123