Provider Demographics
NPI:1659317550
Name:HILLSDALE COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:HILLSDALE COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-437-5232
Mailing Address - Street 1:49 E CARLETON RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-1619
Mailing Address - Country:US
Mailing Address - Phone:517-439-5740
Mailing Address - Fax:517-439-5735
Practice Address - Street 1:49 E CARLETON RD
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242-1619
Practice Address - Country:US
Practice Address - Phone:517-439-5740
Practice Address - Fax:517-439-5735
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HILLSDALE COMMUNITY HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-21
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOE140OtherBLUE CROSS
MI3326150Medicaid
MIOE140OtherBLUE CROSS