NPIMap

Organization Active NPI

Trinity Health - Michigan

Doing business as Mercy Health pharmacy - Long Term Care

  • Long Term Care Pharmacy
  • Grand Rapids, MI
National Provider Identifier
1295761914
Registry record updated May 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
5301005760 Issued in MI
Legal business name
TRINITY HEALTH - MICHIGAN
Doing business as
Mercy Health pharmacy - Long Term Care
Trinity Health Pharmacy Long Term Care-Cathedral Square
Practice address
360 Division Ave S
Ste 1C
Grand Rapids, MI 49503-4501
Phone
(616) 685-1100
Fax
(616) 685-1196
NPI assigned
Jun 24, 2006
Last updated
May 24, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
TRINITY HEALTH - MICHIGANAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Casalou
Title
President/Ceo
Phone
(734) 712-3792

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Long Term Care Pharmacy 3336L0003X 5301005760 MI Primary

Addresses

Primary practice location

360 Division Ave S
Ste 1C
Grand Rapids, MI 49503-4501

Mailing address

360 Division Ave S
Ste 1C
Grand Rapids, MI 49503-4501
Phone (616) 685-1100

Other identifiers 2

IdentifierTypeStateIssuer
4825128MedicaidMI
2042216OtherPK

Other names 2

  • Mercy Health pharmacy - Long Term Care Doing business as
  • Trinity Health Pharmacy Long Term Care-Cathedral Square Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mercy Health Center18 organizations share this tax ID, including this one
Part of
Mercy Health Center

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

360 Division Ave S
Ste 1C
Grand Rapids, MI 49503
Phone (616) 685-1100

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684886400000",
    "number": "1295761914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 DIVISION AVE S",
            "address_2": "STE 1C",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034501",
            "telephone_number": "616-685-1100",
            "fax_number": "616-685-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 DIVISION AVE S",
            "address_2": "STE 1C",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034501",
            "telephone_number": "616-685-1100",
            "fax_number": "616-685-1196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY HEALTH - MICHIGAN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRINITY HEALTH - MICHIGAN",
        "enumeration_date": "2006-06-24",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A",
        "authorized_official_last_name": "CASALOU",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "734-712-3792"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MI",
            "license": "5301005760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4825128",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2042216",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Health pharmacy - Long Term Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mercy Health pharmacy - Long Term Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Trinity Health Pharmacy Long Term Care-Cathedral Square",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.