Provider Demographics
NPI:1225036395
Name:ATRIUM GLADWIN INC.
Entity Type:Organization
Organization Name:ATRIUM GLADWIN INC.
Other - Org Name:GLADWIN NURSING AND REHABILITATION COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-416-0600
Mailing Address - Street 1:5000 HAKES DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5574
Mailing Address - Country:US
Mailing Address - Phone:231-799-6870
Mailing Address - Fax:231-799-0250
Practice Address - Street 1:3270 PRATT LAKE RD
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-8901
Practice Address - Country:US
Practice Address - Phone:989-426-7275
Practice Address - Fax:989-426-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26-4020314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI60 3425426Medicaid
MI09824OtherBCBS PROVIDER CODE
MI23-5335Medicare ID - Type Unspecified