# ATRIUM ROOSEVELT PARK LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Roosevelt Park Nursing and Rehabilitation Community, Roosevelt Park Nursing Centre, Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255339354
- **Authorized official:** DENNIS LOCKHART (CHIEF ACCOUNTING OFFICER)
- **Authorized official phone:** (614) 416-0600

## Contact information

- **Practice address:** 1300 W BROADWAY AVE, MUSKEGON, MI 49441-3530
- **Practice address phone:** (231) 755-2221
- **Practice address fax:** (231) 755-3142
- **Mailing address:** 1300 W BROADWAY AVE, MUSKEGON, MI 49441-3530
- **Mailing address phone:** (231) 755-2221
- **Mailing address fax:** (231) 755-3142

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 61-4080 | MI | Yes |

## Other

- **Enumeration date:** 07/12/2005
- **Last updated:** 03/03/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 09692 | BCBS PROVIDER CODE | MI |
| 05 | — | 60 1642830 | — | MI |