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Organization
GREAT LAKES SPECIALTY HOSPTIAL - HACKLEY LLC
Active
Organization
GREAT LAKES SPECIALTY HOSPTIAL - HACKLEY LLC
Active
Other names
Select Specialty Hospital - Muskegon
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL E. TARVIN (VICE PRESIDENT)
(717) 972-1100
Entity
Organization
Contact information
Practice address
1700 CLINTON ST, 2 SOUTH, 2ND AND 3RD FLOORS, MUSKEGON, MI 49442-5502
(231) 728-5803
(231) 728-5820
Mailing address
4714 GETTYSBURG RD, LEGAL DEPT., MECHANICSBURG, PA 17055-4325
(717) 972-1100
(717) 975-9981
Taxonomy
Speciality
Code
Description
License number
State
282E00000X
Long Term Care Hospital
Primary
610057
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00347
BCBS MI
MI
Enumeration date
07/28/2005
Last updated
09/29/2015
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