Provider Demographics
NPI:1043413370
Name:HELEN NEWBERRY JOY HOSPITAL
Entity type:Organization
Organization Name:HELEN NEWBERRY JOY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:HELLERSTEDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-293-9247
Mailing Address - Street 1:502 W HARRIE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:MI
Mailing Address - Zip Code:49868-1209
Mailing Address - Country:US
Mailing Address - Phone:906-293-9233
Mailing Address - Fax:906-293-9285
Practice Address - Street 1:502 W HARRIE ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:MI
Practice Address - Zip Code:49868-1209
Practice Address - Country:US
Practice Address - Phone:906-293-9233
Practice Address - Fax:906-293-9285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI480020363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010D81004OtherBCBS GROUP 4 CNP