=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629701206
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAINT JOSEPH MERCY LIVINGSTON HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2022
-----------------------------------------------------
Last Update Date | 07/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 620 BYRON RD
-----------------------------------------------------
City | HOWELL
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48843-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-545-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20555 VICTOR PKWY
-----------------------------------------------------
City | LIVONIA
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48152-7031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-343-3925
-----------------------------------------------------
Fax | 312-957-3997
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGIONAL CFO
-----------------------------------------------------
Name | MICHAEL PAUL GUSHO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 231-672-3886
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------