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General NPI Number Information
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NPI Number | 1457355851
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Entity Type | Organization
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Legal Business Name | BRONSN LAKEVIEW HOSPITAL
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 11/03/2008
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Provider Practice Location Address
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Address Line | 822 E MICHIGAN AVE
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City | PAW PAW
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State | MI
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Zip | 49079-1215
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Country | US
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Telephone | 269-657-2800
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Fax | 269-657-1676
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Provider Business Mailing Address
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Address Line | 822 E MICHIGAN AVE
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City | PAW PAW
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State | MI
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Zip | 49079-1215
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Country | US
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Telephone | 269-657-2800
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Fax | 269-657-1676
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Authorized Official
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Title or Position | VICE PRESIDENT , FINANCE
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Name | MARY M MEITZ
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Credential |
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Telephone | 269-341-7654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 15905
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License Number State | MI
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