Provider Demographics
NPI:1619095718
Name:DECKERVILLE COMMUNITY HOSPITAL, INC
Entity Type:Organization
Organization Name:DECKERVILLE COMMUNITY HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-376-2835
Mailing Address - Street 1:3559 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:DECKERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48427
Mailing Address - Country:US
Mailing Address - Phone:810-376-2835
Mailing Address - Fax:810-376-9412
Practice Address - Street 1:3559 PINE STREET
Practice Address - Street 2:
Practice Address - City:DECKERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48427
Practice Address - Country:US
Practice Address - Phone:810-376-2835
Practice Address - Fax:810-376-9412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI760010282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI201OtherBCBSM
MI1557570Medicaid
MI23-1311Medicare UPIN
231311Medicare ID - Type Unspecified
MI1557570Medicaid
MI76165OtherPPOM