Provider Demographics
NPI:1356764674
Name:HACKLEY HEALTHCARE EQUIPMENT
Entity type:Organization
Organization Name:HACKLEY HEALTHCARE EQUIPMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-672-4888
Mailing Address - Street 1:1124 E HACKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1874
Mailing Address - Country:US
Mailing Address - Phone:231-672-4711
Mailing Address - Fax:231-722-2625
Practice Address - Street 1:245 CHERRY ST SE
Practice Address - Street 2:STE 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4607
Practice Address - Country:US
Practice Address - Phone:616-685-5363
Practice Address - Fax:616-685-5365
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HACKLEY HEALTH VENTURES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-22
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1640291Medicaid
MI1640291Medicaid