Provider Demographics
NPI:1194182550
Name:HOSPICE OF NORTH OTTAWA COMMUNITY INC
Entity Type:Organization
Organization Name:HOSPICE OF NORTH OTTAWA COMMUNITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTYNOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-690-2520
Mailing Address - Street 1:1061 S BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2587
Mailing Address - Country:US
Mailing Address - Phone:616-846-2015
Mailing Address - Fax:
Practice Address - Street 1:1027 S BEACON BLVD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2607
Practice Address - Country:US
Practice Address - Phone:616-846-2015
Practice Address - Fax:616-846-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI703511251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1459188Medicaid