Healthcare Provider Details

I. General information

NPI: 1376196691
Provider Name (Legal Business Name): THREE RIVERS HEALTH SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 JEFFERSON ST
THREE RIVERS MI
49093-1024
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 269-279-1130
  • Fax: 269-273-1139
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY COSTELLO
Title or Position: CFO, CHIEF FINANCIAL OFFICER
Credential:
Phone: 574-647-3460