Provider Demographics
NPI:1528408762
Name:CHELSEA COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:CHELSEA COMMUNITY HOSPITAL
Other - Org Name:CHELSEACARE HOME MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-858-6174
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-0457
Mailing Address - Country:US
Mailing Address - Phone:734-593-5910
Mailing Address - Fax:734-593-5915
Practice Address - Street 1:5305 MCAULEY DR
Practice Address - Street 2:SUITE IB55
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1051
Practice Address - Country:US
Practice Address - Phone:734-712-2100
Practice Address - Fax:734-712-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0449850002Medicare NSC
MI872631090Medicaid