Provider Demographics
NPI:1700208444
Name:HACKLEY HEALTHCARE EQUIPMENT
Entity Type:Organization
Organization Name:HACKLEY HEALTHCARE EQUIPMENT
Other - Org Name:MERCY HEALTH HEALTHCARE EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:231-861-3030
Mailing Address - Street 1:1124 E HACKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1874
Mailing Address - Country:US
Mailing Address - Phone:231-672-4711
Mailing Address - Fax:231-722-2625
Practice Address - Street 1:200 JEFFERSON AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4502
Practice Address - Country:US
Practice Address - Phone:616-685-5335
Practice Address - Fax:616-685-5325
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HACKLEY HEALTH VENTURES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1640291Medicaid
MI0281990001Medicare NSC