Basic Information
Provider Information | |||||||||
NPI: | 1437234382 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HOLLAND COMMUNITY HOSPITAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | HOLLAND HOSPITAL | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 602 MICHIGAN AVE | ||||||||
Address2: |   | ||||||||
City: | HOLLAND | ||||||||
State: | MI | ||||||||
PostalCode: | 494234918 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6163925141 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 602 MICHIGAN AVE | ||||||||
Address2: |   | ||||||||
City: | HOLLAND | ||||||||
State: | MI | ||||||||
PostalCode: | 494234918 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6163925141 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/26/2006 | ||||||||
LastUpdateDate: | 08/26/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | STEELE | ||||||||
AuthorizedOfficialFirstName: | TERRY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CFO / VP FINANCE | ||||||||
AuthorizedOfficialTelephone: | 6163925141 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X |   |   | Y |   | Hospitals | Psychiatric Hospital |   |
ID Information
ID | Type | State | Issuer | Description | 00130 | 01 | MI | BCBSM | OTHER | P00130 | 01 | MI | BCN | OTHER | 650 | 01 | MI | PRIORITY HEALTH | OTHER | M019398 | 01 | MI | CHAMPUS INPATIENT PSYCH | OTHER |