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:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI282NC0060X, 282N00000X, 314000000X, 313M00000X, 275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
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