Healthcare Provider Details

I. General information

NPI: 1811891104
Provider Name (Legal Business Name): HACKLEY COMMUNITY CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2187 SHETTLER RD
MUSKEGON MI
49444-4371
US

IV. Provider business mailing address

2700 BAKER ST
MUSKEGON MI
49444-2157
US

V. Phone/Fax

Practice location:
  • Phone: 231-737-7595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL

VIII. Authorized Official

Name: KATIE MOSLEY
Title or Position: BILLING MANAGER
Credential:
Phone: 231-733-6876