Provider Demographics
NPI:1518953272
Name:HOSPICE OF NORTH OTTAWA COMMUNITY, INC.
Entity Type:Organization
Organization Name:HOSPICE OF NORTH OTTAWA COMMUNITY, INC.
Other - Org Name:THAH - GRAND HAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-283-4006
Mailing Address - Street 1:PO BOX 532020
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48153-2020
Mailing Address - Country:US
Mailing Address - Phone:877-827-0788
Mailing Address - Fax:616-846-7227
Practice Address - Street 1:1027 S BEACON BLVD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2607
Practice Address - Country:US
Practice Address - Phone:616-846-2015
Practice Address - Fax:616-846-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08723OtherBLUE CROSS BLUE SHIELD
MI2669875Medicaid
MI2669875Medicaid