# PENNOCK HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PENNOCK HOSPITAL
- **Other names:** Corewell Health Pennock Hospital Family Medicine - Lake Odessa, Spectrum Health Pennock Family Medicine - Lake Odessa
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1962889584
- **Legal business name:** PENNOCK HOSPITAL
- **Authorized official:** JOHN SELLA (CONTROLLER)
- **Authorized official phone:** (616) 802-0206

## Contact information

- **Practice address:** 4294 LAUREL DR, LAKE ODESSA, MI 48849-8430
- **Practice address phone:** (616) 374-7660
- **Practice address fax:** (616) 374-0270
- **Mailing address:** 100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/04/2015
- **Last updated:** 08/23/2023