Provider Demographics
NPI:1235126871
Name:NORTH OTTAWA COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:NORTH OTTAWA COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOITEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:616-846-2015
Mailing Address - Street 1:1061 S BEACON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2587
Mailing Address - Country:US
Mailing Address - Phone:616-847-9090
Mailing Address - Fax:
Practice Address - Street 1:1061 S BEACON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2587
Practice Address - Country:US
Practice Address - Phone:616-847-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1496349-15Medicaid
MIOE124OtherBLUE CROSS BLUE SHIELD
MI=========004OtherTRICARE
MI1496349-15Medicaid