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NPI Code Detail

MEDICARE: ATRIUM COUNTRYSIDE LLC

MEDICARE: ATRIUM COUNTRYSIDE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility80-4050MI
2310400000XAssisted Living FacilityAH800236748MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1S 9517OTHERMIBCBS PROVIDER CODE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497753834
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATRIUM COUNTRYSIDE LLC
Provider Business Mailing Address
First Line : 5000 HAKES DR
Second Line : SUITE 600
City : NORTON SHORES
State : MI
Zip : 49441-5574
Country : US
Telephone Number : 231-799-6870
Fax Number : 231-799-0250
Provider Business Practice Location Address
First Line : 120 BASELINE RD
Second Line :
City : SOUTH HAVEN
State : MI
Zip : 49090-1037
Country : US
Telephone Number : 269-637-8411
Fax Number : 269-637-8460
Authorized Official
Title or Position : CHIEF ACCOUNTING OFFICER
Name : DENNIS LOCKHART
Credential :
Telephone Number : 614-416-0600
Provider Enumeration Date : 07/11/2005
Last Update Date : 02/13/2014

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Directions to “ATRIUM COUNTRYSIDE LLC ” Practice Location

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