=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477640084
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKELAND HOSPITALS AT NILES AND ST JOSEPH, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 08/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1234 NAPIER AVE
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49085-2112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-983-8300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 410
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49085-0410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-428-2574
-----------------------------------------------------
Fax | 269-428-0490
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MATTHEW E COX
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 616-391-1663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number | 110050
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------