Provider Demographics
NPI:1073588034
Name:CARELINK OF JACKSON, A COMMUNITY-OWNED SPECIALTY HOSPITAL
Entity Type:Organization
Organization Name:CARELINK OF JACKSON, A COMMUNITY-OWNED SPECIALTY HOSPITAL
Other - Org Name:HENRY FORD ALLEGIANCE CARELINK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP - CMO, CEO - HFAMG
Authorized Official - Prefix:MS
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-205-6407
Mailing Address - Street 1:110 N. ELM AVENUE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3595
Mailing Address - Country:US
Mailing Address - Phone:517-796-4475
Mailing Address - Fax:517-787-5226
Practice Address - Street 1:110 N. ELM AVENUE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3595
Practice Address - Country:US
Practice Address - Phone:517-796-4475
Practice Address - Fax:517-787-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI380051282E00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1556625Medicaid
MI17008OtherBLUE CROSS
MI7188892OtherPHYSICIANS HEALTH PLAN
MI1556625Medicaid