Provider Demographics
NPI:1700260916
Name:TRINITY HEALTH-MICHIGAN
Entity type:Organization
Organization Name:TRINITY HEALTH-MICHIGAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CASALOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-712-3792
Mailing Address - Street 1:6050 NORTHLAND DR NE
Mailing Address - Street 2:SUITE 1107
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9256
Mailing Address - Country:US
Mailing Address - Phone:616-685-7990
Mailing Address - Fax:616-685-7998
Practice Address - Street 1:6050 NORTHLAND DR NE
Practice Address - Street 2:SUITE 1107
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9256
Practice Address - Country:US
Practice Address - Phone:616-685-7990
Practice Address - Fax:616-685-7998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH - MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-17
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010107063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1700260916Medicaid