Provider Demographics
NPI:1659440816
Name:COUNTY OF MUSKEGON
Entity Type:Organization
Organization Name:COUNTY OF MUSKEGON
Other - Org Name:BROOKHAVEN MEDICAL CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTFLEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-724-3500
Mailing Address - Street 1:1890 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-4245
Mailing Address - Country:US
Mailing Address - Phone:231-724-3500
Mailing Address - Fax:231-724-3571
Practice Address - Street 1:1890 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4245
Practice Address - Country:US
Practice Address - Phone:231-724-3500
Practice Address - Fax:231-724-3571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI618510314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2085268Medicaid
MI2085268Medicaid