Provider Demographics
NPI:1528064466
Name:LEELANAU MEMORIAL HEALTH CENTER
Entity type:Organization
Organization Name:LEELANAU MEMORIAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATHRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-935-6181
Mailing Address - Street 1:215 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NORHTPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49670
Mailing Address - Country:US
Mailing Address - Phone:231-935-6181
Mailing Address - Fax:231-935-7952
Practice Address - Street 1:215 HIGH ST
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:MI
Practice Address - Zip Code:49670
Practice Address - Country:US
Practice Address - Phone:231-935-6181
Practice Address - Fax:231-935-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI282NC0060X, 282N00000X, 314000000X, 313M00000X, 275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2000411Medicaid
MI15167OtherBLUE CROSS LTC PRIMARY
MI5171092Medicaid
MI00167OtherBLUE CROSS FACILITY
MI1562631Medicaid
MI09759OtherBLUE CROSS LTC SECONDARY
MI231302Medicare ID - Type UnspecifiedFACILITY
MI09759OtherBLUE CROSS LTC SECONDARY