Healthcare Provider Details

I. General information

NPI: 1487751277
Provider Name (Legal Business Name): LAKELAND HOSPITALS AT NILES AND ST JOSEPH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LONG MEADOW VILLAGE DR
NILES MI
49120-7808
US

IV. Provider business mailing address

PO BOX 410
SAINT JOSEPH MI
49085-0410
US

V. Phone/Fax

Practice location:
  • Phone: 269-428-7481
  • Fax: 269-428-7477
Mailing address:
  • Phone: 269-428-2574
  • Fax: 269-428-0490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number110050
License Number StateMI

VIII. Authorized Official

Name: MR. TIM CALHOUN
Title or Position: VP FINANCE/CFO
Credential:
Phone: 269-983-8300