Healthcare Provider Details

I. General information

NPI: 1164908703
Provider Name (Legal Business Name): HARBOR BEACH COMMUNITY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 N LAKESHORE RD
PORT HOPE MI
48468
US

IV. Provider business mailing address

4255 N LAKESHORE RD
PORT HOPE MI
48468-9396
US

V. Phone/Fax

Practice location:
  • Phone: 989-428-1000
  • Fax: 989-428-1001
Mailing address:
  • Phone: 989-428-1000
  • Fax: 989-428-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704266641
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JILL WEHNER
Title or Position: PRESIDENT
Credential:
Phone: 989-479-5013