Healthcare Provider Details

I. General information

NPI: 1053781625
Provider Name (Legal Business Name): CARELINK OF JACKSON, A COMMUNITY-OWNED SPECIALTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N ELM AVE
JACKSON MI
49202-3571
US

IV. Provider business mailing address

110 N ELM AVE
JACKSON MI
49202-3571
US

V. Phone/Fax

Practice location:
  • Phone: 517-796-4475
  • Fax: 517-787-5226
Mailing address:
  • Phone: 517-796-4475
  • Fax: 517-787-5226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: MARK SMITH
Title or Position: SVP - CMO, CEO - HFAMG
Credential:
Phone: 517-205-6407