Provider Demographics
NPI:1689650160
Name:MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Entity Type:Organization
Organization Name:MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Other - Org Name:SPECTRUM HEALTH LUDINGTON HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-845-2251
Mailing Address - Street 1:1 N ATKINSON DR
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1906
Mailing Address - Country:US
Mailing Address - Phone:231-845-2270
Mailing Address - Fax:231-845-2259
Practice Address - Street 1:1N ATKINSON DR
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1906
Practice Address - Country:US
Practice Address - Phone:231-845-2270
Practice Address - Fax:231-845-2259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI538611251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2677634Medicaid
MI2677634Medicaid