Active NPI
Lakeland Specialty Hospital at Berrien Center
- Long Term Care Hospital
- Berrien Center, MI
National Provider Identifier
1295767333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Long Term Care Hospital
- License
- 110080
- Legal business name
- LAKELAND SPECIALTY HOSPITAL AT BERRIEN CENTER
- Practice address
- 6418 Deans Hill Rd
Berrien Center, MI 49102-9750 - Phone
- (269) 473-3003
- Fax
- (269) 473-3010
- NPI assigned
- Jul 7, 2006
- Last updated
- Jun 3, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Tim Calhoun
- Title
- Cfo/VP of Finance
- Phone
- (269) 983-8398
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Long Term Care Hospital | 282E00000X | 110080 | MI | Primary |
Addresses
Primary practice location
6418 Deans Hill Rd
Berrien Center, MI 49102-9750
Mailing address
PO Box 800
Saint Joseph, MI 49085-0800
Phone (269) 428-2574
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4172264 | Medicaid | MI | |
| 00323 | Other | BLUE CROSS | |
| 4172246 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI to CCN mapping 3
The Medicare certification numbers (CCNs) connected to NPI 1295767333. Details of each certification follow.
Hospital certification: CCN 230125
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- BERRIEN GENERAL HOSPITAL
- Certification status
- Terminated Voluntary: merger or closure, Oct 1, 1996
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Aug 3, 1989
- Beds
- 55
- Ownership / control type
- Local
- Most recent change of ownership
- Oct 28, 1996 (2 total)
- Facility address
- 6418 Deans Hill Rd
Berrien Center, MI 49102
Hospital certification: CCN 230287
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- LAKELAND SPECIALTY HOSP AT BERRIEN CTR
- Certification status
- Terminated Other: provider status change, Jan 1, 2000
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jun 15, 1999
- Last certification
- Jun 15, 1999
- Beds
- 55 (29 certified)
- Ownership / control type
- Other
- Facility address
- 6418 Deans Hill Rd
Berrien Center, MI 49102
Hospital certification: CCN 232025
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- LAKELAND SPECIALTY HOSPITAL AT BERRIEN CENTER
- Certification status
- Terminated Voluntary: merger or closure, Jun 1, 2014
- Provider type (POS)
- Hospital – Long-term
- Participating since
- Jan 1, 2000
- Last certification
- Jun 16, 1999
- Beds
- 55 (29 certified)
- Ownership / control type
- Other
- Facility address
- 6418 Deans Hill Rd
Berrien Center, MI 49102
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1212451200000",
"number": "1295767333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 800",
"city": "SAINT JOSEPH",
"state": "MI",
"postal_code": "490850800",
"telephone_number": "269-428-2574",
"fax_number": "269-428-0490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6418 DEANS HILL RD",
"city": "BERRIEN CENTER",
"state": "MI",
"postal_code": "491029750",
"telephone_number": "269-473-3003",
"fax_number": "269-473-3010"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LAKELAND SPECIALTY HOSPITAL AT BERRIEN CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-07",
"last_updated": "2008-06-03",
"status": "A",
"authorized_official_last_name": "CALHOUN",
"authorized_official_first_name": "TIM",
"authorized_official_title_or_position": "CFO/VP OF FINANCE",
"authorized_official_telephone_number": "269-983-8398",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "282E00000X",
"taxonomy_group": "",
"desc": "Long Term Care Hospital",
"state": "MI",
"license": "110080",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4172264",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "00323",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4172246",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Berrien Center, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.