Provider Demographics
NPI: | 1326821331 |
---|---|
Name: | PENNOCK HOSPITAL |
Entity Type: | Organization |
Organization Name: | PENNOCK HOSPITAL |
Other - Org Name: | COREWELL HEALTH PENNOCK HOSPITAL |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP, PROVIDER SERVICES |
Authorized Official - Prefix: | |
Authorized Official - First Name: | RYAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | CATIGNANI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 947-522-0008 |
Mailing Address - Street 1: | 100 MICHIGAN ST NE |
Mailing Address - Street 2: | |
Mailing Address - City: | GRAND RAPIDS |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 49503-2560 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 616-486-6790 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 520 W SOUTH ST |
Practice Address - Street 2: | |
Practice Address - City: | HASTINGS |
Practice Address - State: | MI |
Practice Address - Zip Code: | 49058-2156 |
Practice Address - Country: | US |
Practice Address - Phone: | 616-486-6790 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | PENNOCK HOSPITAL |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2023-08-15 |
Last Update Date: | 2023-10-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1041S0200X | Behavioral Health & Social Service Providers | Social Worker | School | Group - Multi-Specialty |