Provider Demographics
NPI:1871591214
Name:ATRIUM ALLENDALE LLC
Entity type:Organization
Organization Name:ATRIUM ALLENDALE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ACCOUNTING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-416-0600
Mailing Address - Street 1:11007 RADCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-9521
Mailing Address - Country:US
Mailing Address - Phone:616-895-6688
Mailing Address - Fax:616-895-5071
Practice Address - Street 1:11007 RADCLIFF DR
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-9521
Practice Address - Country:US
Practice Address - Phone:616-895-6688
Practice Address - Fax:616-895-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI70-4120314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09758OtherBCBS PROVIDER CODE
MI603154350Medicaid
MI603154350Medicaid