Provider Demographics
NPI:1013799469
Name:DECKERVILLE COMMUNITY HOSPITAL, INC
Entity Type:Organization
Organization Name:DECKERVILLE COMMUNITY HOSPITAL, INC
Other - Org Name:PORT SANILAC HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCONNACHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-635-4000
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:DECKERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48427-0126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:245 S RIDGE ST
Practice Address - Street 2:
Practice Address - City:PORT SANILAC
Practice Address - State:MI
Practice Address - Zip Code:48469-9704
Practice Address - Country:US
Practice Address - Phone:810-376-2835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DECKERVILLE COMMUNITY HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-19
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center