Provider Demographics
NPI:1285722751
Name:CHELSEA COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:CHELSEA COMMUNITY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER, RETAIL PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:734-593-5900
Mailing Address - Street 1:14650 E OLD US HIGHWAY 12
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1801
Mailing Address - Country:US
Mailing Address - Phone:734-593-5900
Mailing Address - Fax:734-593-5905
Practice Address - Street 1:14650 E OLD US HIGHWAY 12
Practice Address - Street 2:SUITE 103
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1801
Practice Address - Country:US
Practice Address - Phone:734-593-5900
Practice Address - Fax:734-593-5905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53010091043336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1285722750Medicaid
2120823OtherPK