Provider Demographics
NPI:1508865296
Name:MICHIGAN CHRISTIAN HOME
Entity Type:Organization
Organization Name:MICHIGAN CHRISTIAN HOME
Other - Org Name:BEACON HILL AT EASTGATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUEGLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-245-9179
Mailing Address - Street 1:1919 BOSTON SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4499
Mailing Address - Country:US
Mailing Address - Phone:616-245-9179
Mailing Address - Fax:616-608-8282
Practice Address - Street 1:1845 BOSTON SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4499
Practice Address - Country:US
Practice Address - Phone:616-245-9179
Practice Address - Fax:616-245-0572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAH410236848310400000X
MI414200314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2081349Medicaid
MI235633Medicare Oscar/Certification