GREAT LAKES SPECIALTY HOSPTIAL - HACKLEY LLC (NPI# 1245230671) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245230671 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES SPECIALTY HOSPTIAL - HACKLEY LLC |
| Other Organization Name | SELECT SPECIALTY HOSPITAL - MUSKEGON |
| Practice Address |
1700 Clinton St 2 South, 2nd and 3rd Floors Muskegon MI 49442-5502 |
| Mailing Address |
4714 Gettysburg Rd Legal Dept. Mechanicsburg PA 17055-4325 |
| Practice Telephone | 2317285803 |
| Practice Fax Number | 2317285820 |
| Mailing Telephone | 7179721100 |
| Mailing Fax Number | 7179759981 |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2015-09-29 |
| Authorized Official Name | MR. MICHAEL E. TARVIN (VICE PRESIDENT) |
| Authorized Official Telephone | 7179721100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282E00000X | Long Term Care Hospital | 610057 | MI | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBS MI | 00347 | 01 |
| Other Name | Type Code |
|---|---|
| Select Specialty Hospital - Muskegon | Doing Business As Name - Organization |
| Street Address |
1700 CLINTON ST 2 SOUTH, 2ND AND 3RD FLOORS |
| City | MUSKEGON |
| State | MI |
| Zip Code | 49442-5502 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619594959 | Marstie Sue Bunting | Registered Nurse | 1700 Clinton St, Muskegon, MI 49442-5502 | 2020-07-02 |
| 1164044830 | Justin R Staley | Student in an Organized Health Care Education/Training Program | 1700 Clinton St, Muskegon, MI 49442-5502 | 2020-05-15 |
| 1184253312 | Bernadette Mcdermott Dazzo | Student in an Organized Health Care Education/Training Program | 1700 Clinton St, Muskegon, MI 49442-5502 | 2020-04-08 |
| 1205465143 | Eric James Applebach | Student in an Organized Health Care Education/Training Program | 1700 Clinton St, Muskegon, MI 49442-5502 | 2020-04-03 |
| 1982233888 | Hannah Grace Keirnan Skok | Student in an Organized Health Care Education/Training Program | 1700 Clinton St, Muskegon, MI 49442-5502 | 2020-04-03 |
| 1114556073 | Uzair Mohammad Raja | Student in an Organized Health Care Education/Training Program | 1700 Clinton St, Muskegon, MI 49442-5502 | 2020-04-03 |
| 1730718784 | Angelic Shonta Dye | Student in an Organized Health Care Education/Training Program | 1700 Clinton St, Muskegon, MI 49442-5502 | 2020-04-02 |
| 1932738960 | Stephanie Elizabeth Song | Student in an Organized Health Care Education/Training Program | 1700 Clinton St, Muskegon, MI 49442-5502 | 2020-04-02 |
| 1578199477 | Brigid M Kiley | Emergency Medicine | 1700 Clinton St, Muskegon, MI 49442-5502 | 2020-03-23 |
| 1417517236 | Johnathan Patrick Lewis | Student in an Organized Health Care Education/Training Program | 1700 Clinton St, Muskegon, MI 49442-5502 | 2019-06-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205472321 | Beacon of Light Counseling LLC | Social Worker | 1515 E Laketon Ave, Muskegon, MI 49442 | 2019-11-24 |
| 1528524410 | Tyler Companion | Social Worker | 710 Mclaughlin, Muskegon, MI 49442 | 2019-02-15 |
| 1427549658 | Amber Renee Davidson | Behavioral Analyst | 1175 Wesley Street, Muskegon, MI 49442 | 2018-05-23 |
| 1528559085 | Katherine Dale Kirby | Obstetrics & Gynecology | Mercy Health Hackley, 1700 Clinton St., Muskegon, MI 49442 | 2018-05-21 |
| 1023524303 | Aaron James Dortch | Social Worker | 571 E Appleave, Muskegon, MI 49442 | 2017-12-21 |
| 1043737554 | Jessica Nicole Moskalewski | Social Worker | 125 E. Catherine, Muskegon, MI 49442 | 2017-08-25 |
| 1427587831 | Cristina J Walcott | Social Worker | 1611 Oak Avenue, Muskegon, MI 49442 | 2017-06-08 |
| 1104352244 | Jessica Lee Bailey-yabani | Counselor | 35 S Sheridan Dr, Muskegon, MI 49442 | 2017-05-11 |
| 1538514518 | Andrew G Gregson | Internal Medicine | 1675 Leahy Street Suite 201a, Muskegon, MI 49442 | 2016-04-27 |
| 1487038287 | Mark Charles Kaufman | Social Worker | 1611 Oak Ave., Muskegon, MI 49442 | 2015-07-13 |
| Find all providers in zip 49442 | ||||
| Taxonomy Code | 282E00000X |
| Grouping | Hospitals |
| Classification | Long Term Care Hospital |
| Long-term care hospitals (LTCHs) furnish extended medical and rehabilitative care to individuals who are clinically complex and have multiple acute or chronic conditions. |
| Notes: Source: American Hospital Association [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972032209 | Special Care Hospital, LLC | Long Term Care Hospital | 1840 Wealthy St Se Fl 5, Grand Rapids, MI 49506-2921 | 2017-06-09 |
| 1508027624 | Vibra of Southeastern Michigan LLC | Long Term Care Hospital | 26400 West Outer Dr, Lincoln Park, MI 48146-2088 | 2008-06-20 |
| 1962512863 | Mclaren Bay Special Care | Long Term Care Hospital | 3250 E Midland Rd Ste 1, Bay City, MI 48706-2835 | 2006-08-30 |
| 1801872379 | Scci Hospitals of America Inc. | Long Term Care Hospital | 4777 East Outer Drive, Detroit, MI 48234-3241 | 2005-12-16 |
| 1205836806 | Select Specialty Hospital - Northwest Detroit Inc | Long Term Care Hospital | 6071 W Outer Dr, 7th Floor, Detroit, MI 48235-2624 | 2005-07-26 |
| 1912907635 | Select Specialty Hospital - Macomb County Inc | Long Term Care Hospital | 215 North Ave, Mount Clemens, MI 48043-1716 | 2005-07-22 |
| 1912906934 | Select Specialty Hospital - Flint Inc | Long Term Care Hospital | 401 S Ballenger Hwy, Flint, MI 48532-3638 | 2005-07-20 |
| 1225034895 | Select Specialty Hospital - Battle Creek Inc | Long Term Care Hospital | 300 North Ave, Fl 6, Battle Creek, MI 49017-3307 | 2005-06-28 |
| 1427564855 | Select Specialty Hospital - Macomb County Inc | Long Term Care Hospital | 22101 Moross Rd, Detroit, MI 48236-2148 | 2017-12-21 |
| 1538426655 | Henry Ford Health System | Long Term Care Hospital | 2799 West Grand Blvd, Henry Ford Hospital, Detroit, MI 48101-2608 | 2012-04-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.