Provider Demographics
NPI:1174038111
Name:SAINT JOSEPH MERCY LIVINGSTON HOSPITAL
Entity Type:Organization
Organization Name:SAINT JOSEPH MERCY LIVINGSTON HOSPITAL
Other - Org Name:ST JOSEPH MERCY BRIGHTON CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SE MI REGIONAL CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-398-0642
Mailing Address - Street 1:34505 W 12 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3286
Mailing Address - Country:US
Mailing Address - Phone:734-343-3922
Mailing Address - Fax:
Practice Address - Street 1:7575 GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-9309
Practice Address - Country:US
Practice Address - Phone:810-844-7250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy