=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124089743
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARBOR BEACH COMMUNITY HOSPITAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2006
-----------------------------------------------------
Last Update Date | 03/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 S 1ST ST
-----------------------------------------------------
City | HARBOR BEACH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48441-1236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-479-3201
-----------------------------------------------------
Fax | 989-479-5002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 210 S 1ST ST
-----------------------------------------------------
City | HARBOR BEACH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48441-1236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-479-3201
-----------------------------------------------------
Fax | 989-479-5002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP/COO
-----------------------------------------------------
Name | MR. JILL WEHNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 989-479-3201
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------