Deckerville Community Hospital, Inc.
Organization Active NPI Rural Health Clinic/Center · Deckerville, MI
NPI 1780011247 · NPPES record last updated Sep 2, 2025
Key facts
- NPI
- 1780011247
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- DECKERVILLE COMMUNITY HOSPITAL, INC.
- Practice address
- 2030 Black River St
Deckerville, MI 48427-9440 - Phone
- (810) 376-2885
- NPI assigned
- Sep 30, 2013
- Organization subpart
- Yes
- Parent organization (as reported)
- DECKERVILLE COMMUNITY HOSPITAL, INC.
Authorized official
- Name
- Kimberly Gentner
- Title
- Cfo
- Phone
- (810) 376-2835
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 4
Related certifications (CCN) 3
Practitioners 12
-
Kimberley James, FNP-C
-
Long Hoang Nguyen, M.D.
-
Faraaz Ahmed, MD
-
Rashid Alsabeh, M.D.
-
Majed Alzahabi, DO
-
Nick Buttar, M.D.
-
Keith Davidson, NP-C
-
Stephen Holihan, MD
-
Malorie McVittie, M.D.
-
Emily Jean Puzan, NP
-
Jamie Kozdron, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2096277 | Deckerville Healthcare Services RHC | Certificate of waiver | May 18, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Rural health clinic certification: CCN 238666
- Legal name
- DECKERVILLE COMMUNITY HOSPITAL INC
- Doing business as
- DECKERVILLE HEALTHCARE SERVICES RHC, INC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 27, 2014
- Last certification
- May 27, 2014
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 2030 Black River St
Deckerville, MI 48427-9440 - Related CCNs
- 231311
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Kimberly Gentner |
Corporate Officer |
Apr 15, 2016 | |
| Victoria Meiburg |
Corporate Director |
May 10, 2022 | |
| Gail Ann Denton |
Corporate Director |
Oct 9, 2018 | |
| Angela McConnachie |
Corporate Officer |
Feb 1, 2016 | |
| Alexander Messing |
Corporate Director |
May 10, 2022 | |
| Tiffany Messing |
W-2 Managing Employee | Jan 1, 2015 | |
| Justin Faber |
Corporate Director |
Sep 8, 2020 | |
| Scott Orr |
Corporate Director |
Oct 9, 2018 | |
| Curtis Landrith |
Corporate Director |
Sep 8, 2020 | |
| Daniel Babcock |
Corporate Officer |
Feb 11, 2020 | |
| Sue Cook |
Corporate Director |
May 11, 2021 | |
| David West |
Corporate Director |
Oct 1, 2016 | |
| David Messing |
Corporate Director |
Sep 1, 2017 | |
| Christopher Clark |
Corporate Director |
Oct 9, 2018 | |
| Irene Cole |
Corporate Director |
Oct 9, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130904000878 | MI | Part a Provider - Rural Health Clinic | 2163508821 |
1 other NPI on this enrollment Practice locations: Deckerville, MI |
National Provider Directory
- Tax ID family
- Deckerville Com Hosp ER
- Part of
- Deckerville Com Hosp ER
Locations
2433 Black River St
Deckerville, MI 48427
Phone (810) 376-2835
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
2030 Black River St
Deckerville, MI 48427-9440
Mailing address
2433 Black River St
Deckerville, MI 48427-9425
Phone (810) 376-2885
Other practice location 1
2433 Black River St
Deckerville, MI 48427-9425
Phone (810) 376-2885
Other names
- Deckerville Healthcare Services RHC
Other providers in Deckerville, MI
- Deckerville Community Hospital Inc
- Deckerville Community Hospital, Inc.
- Deckerville Community Hospital, Inc.
- Deckerville Community Hospital, Inc.
- Deckerville Community Hospital, Inc.
- Deckerville Nursing Center, LLC
- Pany Decossard
- Carrie V Eugster
- For the Family Counseling Service PLLC
- Levi L Guerrero
All providers in Deckerville, MI · Rural Health Clinic/Center in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.