Provider Demographics
NPI:1326034000
Name:HEARTWOOD LODGE TRINITY HEALTH
Entity Type:Organization
Organization Name:HEARTWOOD LODGE TRINITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LATOVICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-343-6628
Mailing Address - Street 1:18525 WOODLAND RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-8876
Mailing Address - Country:US
Mailing Address - Phone:616-842-0770
Mailing Address - Fax:
Practice Address - Street 1:18525 WOODLAND RIDGE DR
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-8876
Practice Address - Country:US
Practice Address - Phone:616-842-0770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1326034000Medicaid
MI1675500-60Medicaid
MI09854OtherBLUE CROSS BLUE SHIELD