NPIMap

Organization Active NPI

Hackley Community Care Center Inc

  • Federally Qualified Health Center (FQHC)
  • Fruitport, MI
National Provider Identifier
1386298552
Registry record updated Jul 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HACKLEY COMMUNITY CARE CENTER INC
Practice address
3255 Pontaluna Rd
Fruitport, MI 49415-9600
Phone
(231) 733-6720
NPI assigned
Jul 26, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2019

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

Authorized official

Name
Danielle Koestner, DO
Title
Cmo
Phone
(231) 737-1335

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3255 Pontaluna Rd
Fruitport, MI 49415-9600

Mailing address

2700 Baker St FL 3
Muskegon, MI 49444-2157

Other identifiers 1

IdentifierTypeStateIssuer
1629066238MedicaidMI

Other names 1

  • Edgewood Elementary Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Hackley Community Care30 organizations share this tax ID, including this one

Other organizations with this tax ID 29

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

View all 29

Locations

3255 Pontaluna Rd
Fruitport, MI 49415
Phone (231) 733-6720

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1564099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564099200000",
    "number": "1386298552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 BAKER ST FL 3",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494442157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3255 PONTALUNA RD",
            "city": "FRUITPORT",
            "state": "MI",
            "postal_code": "494159600",
            "telephone_number": "231-733-6720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HACKLEY COMMUNITY CARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-26",
        "last_updated": "2019-07-26",
        "status": "A",
        "authorized_official_last_name": "KOESTNER",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "231-737-1335",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629066238",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgewood Elementary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fruitport, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2019; 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.