Healthcare Provider Details

I. General information

NPI: 1013915115
Provider Name (Legal Business Name): ATRIUM MARSHALL 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

575 N MADISON ST
MARSHALL MI
49068-1148
US

IV. Provider business mailing address

575 N MADISON ST
MARSHALL MI
49068-1148
US

V. Phone/Fax

Practice location:
  • Phone: 269-781-4281
  • Fax: 269-781-9290
Mailing address:
  • Phone: 269-781-4281
  • Fax: 269-781-9290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number13-4120
License Number StateMI

VIII. Authorized Official

Name: DENNIS LOCKHART
Title or Position: CHIEF ACCOUNTING OFFICER
Credential:
Phone: 614-416-0600