Provider Demographics
NPI:1306128228
Name:HUME HOME OF MUSKEGON
Entity type:Organization
Organization Name:HUME HOME OF MUSKEGON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR / ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ZATTLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-755-1715
Mailing Address - Street 1:1244 W SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-2271
Mailing Address - Country:US
Mailing Address - Phone:231-755-1715
Mailing Address - Fax:231-755-3155
Practice Address - Street 1:1244 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-2271
Practice Address - Country:US
Practice Address - Phone:231-755-1715
Practice Address - Fax:231-755-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D1091054291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory