Provider Demographics
NPI:1467480566
Name:SAINT MARY'S HEALTH SERVICES
Entity Type:Organization
Organization Name:SAINT MARY'S HEALTH SERVICES
Other - Org Name:SAINT MARY'S HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-685-6709
Mailing Address - Street 1:1820 44TH ST SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5006
Mailing Address - Country:US
Mailing Address - Phone:616-643-3500
Mailing Address - Fax:616-643-3659
Practice Address - Street 1:200 JEFFERSON AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4502
Practice Address - Country:US
Practice Address - Phone:616-643-3500
Practice Address - Fax:616-643-3659
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH-MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-28
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIH-107/2005273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3203778Medicaid
MI2683284Medicaid
MI23S059Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER