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NPI Code Detail

MEDICARE: ATRIUM ALLENDALE LLC

MEDICARE: ATRIUM ALLENDALE 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 Facility70-4120MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
109758OTHERMIBCBS PROVIDER CODE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871591214
Entity Type Code : Organization
Provider Name (Legal Business Name) : ATRIUM ALLENDALE LLC
Provider Business Mailing Address
First Line : 11007 RADCLIFF DR
Second Line :
City : ALLENDALE
State : MI
Zip : 49401-9521
Country : US
Telephone Number : 616-895-6688
Fax Number : 616-895-5071
Provider Business Practice Location Address
First Line : 11007 RADCLIFF DR
Second Line :
City : ALLENDALE
State : MI
Zip : 49401-9521
Country : US
Telephone Number : 616-895-6688
Fax Number : 616-895-5071
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 : 03/03/2025

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Directions to “ATRIUM ALLENDALE LLC ” Practice Location

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