Provider Demographics
NPI:1912094525
Name:LAKELAND HOSPITALS AT NILES AND ST JOSEPH, INC
Entity Type:Organization
Organization Name:LAKELAND HOSPITALS AT NILES AND ST JOSEPH, INC
Other - Org Name:COREWELL HEALTH LAKELAND HOSPITALS ST. JOSEPH HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:E
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-391-1663
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-0813
Mailing Address - Country:US
Mailing Address - Phone:269-985-4400
Mailing Address - Fax:269-985-4446
Practice Address - Street 1:2550 MEADOWBROOK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-9609
Practice Address - Country:US
Practice Address - Phone:269-985-4400
Practice Address - Fax:269-985-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI110050251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0E034OtherBLUE CROSS
MI1879027Medicaid
237163Medicare Oscar/Certification