Healthcare Provider Details

I. General information

NPI: 1053472522
Provider Name (Legal Business Name): HILLSDALE COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 S MAIN ST
READING MI
49274
US

IV. Provider business mailing address

143 S MAIN ST
READING MI
49274-9101
US

V. Phone/Fax

Practice location:
  • Phone: 517-283-1772
  • Fax:
Mailing address:
  • Phone: 517-283-1772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number233965
License Number StateMI

VIII. Authorized Official

Name: MARK GROSS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 517-437-5232