Provider Demographics
NPI:1861556722
Name:LAKELAND HOSPITAL AT NILES AND ST JOSEPH, INC
Entity type:Organization
Organization Name:LAKELAND HOSPITAL AT NILES AND ST JOSEPH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO VP OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-983-8398
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-0813
Mailing Address - Country:US
Mailing Address - Phone:269-428-2574
Mailing Address - Fax:
Practice Address - Street 1:2550 MEADOWBROOK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-9609
Practice Address - Country:US
Practice Address - Phone:269-985-4401
Practice Address - Fax:269-985-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI118635251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based