Provider Demographics
NPI:1942379284
Name:TRINITY HEALTH GRAND HAVEN HOSPITAL
Entity Type:Organization
Organization Name:TRINITY HEALTH GRAND HAVEN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM REIMBURSEMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLARADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-847-5315
Mailing Address - Street 1:1309 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2404
Mailing Address - Country:US
Mailing Address - Phone:616-842-3600
Mailing Address - Fax:616-847-5621
Practice Address - Street 1:1309 SHELDON RD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2404
Practice Address - Country:US
Practice Address - Phone:616-842-3600
Practice Address - Fax:616-847-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI700010282N00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00162OtherBLUE CROSS
MI14578OtherPRIORITY HEALTH
MI301557130Medicaid
MI00162OtherBLUE CROSS