Provider Demographics
NPI:1730146630
Name:HARBOR BEACH COMMUNITY HOSPITAL INC
Entity type:Organization
Organization Name:HARBOR BEACH COMMUNITY HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-479-3201
Mailing Address - Street 1:210 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HARBOR BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:48441-1236
Mailing Address - Country:US
Mailing Address - Phone:989-479-3201
Mailing Address - Fax:989-479-5002
Practice Address - Street 1:210 S 1ST ST
Practice Address - Street 2:
Practice Address - City:HARBOR BEACH
Practice Address - State:MI
Practice Address - Zip Code:48441-1236
Practice Address - Country:US
Practice Address - Phone:989-479-3201
Practice Address - Fax:989-479-5002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HARBOR BEACH COMMUNITY HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-26
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI320040275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23Z313Medicare Oscar/Certification