Provider Demographics
NPI:1306239314
Name:HOSPICE OF MUSKEGON COUNTY, INC.
Entity type:Organization
Organization Name:HOSPICE OF MUSKEGON COUNTY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, NHA
Authorized Official - Phone:231-728-6820
Mailing Address - Street 1:1050 W WESTERN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-1694
Mailing Address - Country:US
Mailing Address - Phone:231-728-3442
Mailing Address - Fax:231-726-2581
Practice Address - Street 1:1050 W WESTERN AVE
Practice Address - Street 2:STE 400
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-1666
Practice Address - Country:US
Practice Address - Phone:231-728-3442
Practice Address - Fax:231-726-2581
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPICE OF MUSKEGON COUNTY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-16
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI613510207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1791705Medicaid
MI08701OtherBCBS OF MI
MI7402461OtherAETNA
MI231508Medicare Oscar/Certification