Provider Demographics
NPI:1538430236
Name:SHORELINE HEARING CENTER LLC
Entity type:Organization
Organization Name:SHORELINE HEARING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:231-755-0552
Mailing Address - Street 1:941 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3521
Mailing Address - Country:US
Mailing Address - Phone:231-755-0552
Mailing Address - Fax:231-755-5600
Practice Address - Street 1:941 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-3521
Practice Address - Country:US
Practice Address - Phone:231-755-0552
Practice Address - Fax:231-755-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty