Provider Demographics
NPI:1700351657
Name:TRINITY HEALTH - MICHIGAN
Entity Type:Organization
Organization Name:TRINITY HEALTH - MICHIGAN
Other - Org Name:MERCY HEALTH PHARMACY-HUDSONVILLE
Other - Org Type:Doing Business As
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 1:360 DIVISION AVE S STE 1E
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4501
Mailing Address - Country:US
Mailing Address - Phone:616-685-1089
Mailing Address - Fax:616-685-1093
Practice Address - Street 1:3925 32ND AVE STE 200
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-8460
Practice Address - Country:US
Practice Address - Phone:616-685-1540
Practice Address - Fax:616-685-1545
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH - MICHIGAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-08
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1700351657Medicaid