Healthcare Provider Details

I. General information

NPI: 1174439798
Provider Name (Legal Business Name): THREE SHORES HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 WARREN WOODS RD LOT 68
THREE OAKS MI
49128-9573
US

IV. Provider business mailing address

8000 WARREN WOODS RD LOT 68
THREE OAKS MI
49128-9573
US

V. Phone/Fax

Practice location:
  • Phone: 574-220-4676
  • Fax:
Mailing address:
  • Phone: 574-220-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN ANN DECOCKER
Title or Position: OWNER/PROVIDER
Credential: DNP, PMHNP-BC
Phone: 574-220-4676