Provider Demographics
NPI:1154417012
Name:NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:STASIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-924-1340
Mailing Address - Street 1:212 S SULLIVAN AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1548
Mailing Address - Country:US
Mailing Address - Phone:231-924-3300
Mailing Address - Fax:231-924-1856
Practice Address - Street 1:204 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1181
Practice Address - Country:US
Practice Address - Phone:231-924-1122
Practice Address - Fax:231-924-1182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI772947847Medicaid
MI152611786Medicaid
MI772947847Medicaid