Healthcare Provider Details

I. General information

NPI: 1629701206
Provider Name (Legal Business Name): SAINT JOSEPH MERCY LIVINGSTON HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 BYRON RD
HOWELL MI
48843-1002
US

IV. Provider business mailing address

20555 VICTOR PKWY
LIVONIA MI
48152-7031
US

V. Phone/Fax

Practice location:
  • Phone: 517-545-6000
  • Fax:
Mailing address:
  • Phone: 734-343-3925
  • Fax: 312-957-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

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