Provider Demographics
NPI:1710968748
Name:MARQUETTE GENERAL HOSPITAL, INC
Entity Type:Organization
Organization Name:MARQUETTE GENERAL HOSPITAL, INC
Other - Org Name:MARQUETTE GENERAL HOME HEALTH AND HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF HOME HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-228-4325
Mailing Address - Street 1:580 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2705
Mailing Address - Country:US
Mailing Address - Phone:906-228-4325
Mailing Address - Fax:906-225-3642
Practice Address - Street 1:2420 1ST AVENUE SOUTH
Practice Address - Street 2:SUITE 102
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1309
Practice Address - Country:US
Practice Address - Phone:906-789-1305
Practice Address - Fax:906-789-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI213519OtherLICENSE NUMBER
MI4824873Medicaid
MI231571Medicare Oscar/Certification