Healthcare Provider Details

I. General information

NPI: 1689672792
Provider Name (Legal Business Name): ATRIUM SOUTH HAVEN 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

850 PHILLIPS ST
SOUTH HAVEN MI
49090-1845
US

IV. Provider business mailing address

850 PHILLIPS ST
SOUTH HAVEN MI
49090-1845
US

V. Phone/Fax

Practice location:
  • Phone: 269-637-5147
  • Fax: 269-637-4943
Mailing address:
  • Phone: 269-637-5147
  • Fax: 269-637-4943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number80-4030
License Number StateMI

VIII. Authorized Official

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