Provider Demographics
NPI:1770131344
Name:HUTTON, GARTH
Entity type:Individual
Prefix:
First Name:GARTH
Middle Name:
Last Name:HUTTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 TERRITORIAL RD W
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-2751
Mailing Address - Country:US
Mailing Address - Phone:269-964-8125
Mailing Address - Fax:
Practice Address - Street 1:1404 TERRITORIAL RD W
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-2751
Practice Address - Country:US
Practice Address - Phone:269-964-8125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL1303088473104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances