Provider Demographics
NPI:1992988562
Name:HACKLEY HOSPITAL
Entity type:Organization
Organization Name:HACKLEY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUELLERLEILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-728-4753
Mailing Address - Street 1:6401 PRAIRIE ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-7840
Mailing Address - Country:US
Mailing Address - Phone:231-724-7800
Mailing Address - Fax:
Practice Address - Street 1:6401 PRAIRIE ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-7840
Practice Address - Country:US
Practice Address - Phone:231-724-7861
Practice Address - Fax:231-724-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F11214OtherBCN