Provider Demographics
NPI:1164908703
Name:HARBOR BEACH COMMUNITY HOSPITAL INC
Entity Type:Organization
Organization Name:HARBOR BEACH COMMUNITY HOSPITAL INC
Other - Org Name:PORT HOPE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:WEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-479-5013
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:989-479-5003
Practice Address - Street 1:4255 N LAKESHORE RD
Practice Address - Street 2:
Practice Address - City:PORT HOPE
Practice Address - State:MI
Practice Address - Zip Code:48468
Practice Address - Country:US
Practice Address - Phone:989-428-1000
Practice Address - Fax:989-428-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
MI4704266641363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty