Healthcare Provider Details

I. General information

NPI: 1598340655
Provider Name (Legal Business Name): BRONSON SOUTH HAVEN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 S BAILEY AVE
SOUTH HAVEN MI
49090-6743
US

IV. Provider business mailing address

955 S BAILEY AVE
SOUTH HAVEN MI
49090-6743
US

V. Phone/Fax

Practice location:
  • Phone: 269-639-2859
  • Fax: 269-639-2860
Mailing address:
  • Phone: 269-639-2859
  • Fax: 269-639-2860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: REBECCA EAST
Title or Position: CFO
Credential:
Phone: 269-341-6000