Healthcare Provider Details

I. General information

NPI: 1376541474
Provider Name (Legal Business Name): ATRIUM PLAINWELL 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

3260 E B AVE
PLAINWELL MI
49080-8904
US

IV. Provider business mailing address

3260 E B AVE
PLAINWELL MI
49080-8904
US

V. Phone/Fax

Practice location:
  • Phone: 269-349-6649
  • Fax: 269-349-2520
Mailing address:
  • Phone: 269-349-6649
  • Fax: 269-349-2520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number39-4020
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier60 2582503
Identifier TypeMEDICAID
Identifier StateMI
Identifier Issuer
# 2
Identifier09525
Identifier TypeOTHER
Identifier StateMI
Identifier IssuerBCBS PROVIDER CODE

VIII. Authorized Official

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