Provider Demographics
NPI:1457374514
Name:CHELSEA COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:CHELSEA COMMUNITY HOSPITAL
Other - Org Name:ST. JOSEPH MERCY CHELSEA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-858-6174
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-0457
Mailing Address - Country:US
Mailing Address - Phone:734-593-5910
Mailing Address - Fax:734-593-5915
Practice Address - Street 1:14750 E OLD US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1185
Practice Address - Country:US
Practice Address - Phone:734-593-5910
Practice Address - Fax:734-593-5915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH-MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-26
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0449850001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI872631090Medicaid
MI540H103220OtherBLUE CROSS BLUE SHIELD
MI0449850001Medicare NSC