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Organization Active NPI

Select Specialty Hospital - Macomb County Inc

  • Long Term Care Hospital
  • Mount Clemens, MI
National Provider Identifier
1912907635
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care HospitalTaxonomy code 282E00000X
License
500111 Issued in MI
Legal business name
SELECT SPECIALTY HOSPITAL - MACOMB COUNTY INC
Practice address
215 North Ave
Mount Clemens, MI 48043-1716
Phone
(586) 307-9003
Fax
(586) 307-9001
NPI assigned
Jul 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

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

Authorized official

Name
Mr. John Duggan
Title
Vice President
Phone
(717) 972-1100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Long Term Care Hospital 282E00000X 500111 MI Primary

Addresses

Primary practice location

215 North Ave
Mount Clemens, MI 48043-1716

Mailing address

4714 Gettysburg Rd
Legal Dept.
Mechanicsburg, PA 17055-4325
Phone (717) 972-1100

Other identifiers 2

IdentifierTypeStateIssuer
00346OtherMIBCBS MI
3445680MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061114000653 MI Part A Provider - Hospital 9830197599 Practice locations: Mount Clemens, MI; Pontiac, MI

Hospital certification: CCN 232023

Legal name
SELECT SPECIALTY HOSPITAL - MACOMB COUNTY INC
Doing business as
SELECT SPECIALTY HOSPITAL MACOMB COUNTY
Certification status
Active
Provider type (POS)
Hospital – Long-term
Participating since
Jan 1, 1999
Last certification
Jan 2, 1999
Beds
36
Ownership / control type
Private (for profit)
Organization structure
CorporationProprietary
Incorporated
Feb 6, 1997 in MO
Enrollment address
215 North Ave
Mount Clemens, MI 48043-1716
Main/Primary Hospital Location
Hospital subgroups
Long-term

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Long-term care hospital

Medicare Care Compare
Listed as
Select Specialty Hospital-Macomb CountyCCN 232023
Ownership
For profit
Certified
Jan 1, 1999
Medicare certification status
ActiveFrom the Provider of Services file
Beds
36

National Provider Directory

National Provider Directory
Tax ID family
Select Specialty Hospital - Macomb County Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

215 North Ave
Fl 5
Mount Clemens, MI 48043

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Select Medical Corporation Organization, Mechanicsburg, PA Corporation, For-profit Operational/Managerial Control Dec 3, 2010 100%
Thomas Mullin Individual Corporate Officer Sep 5, 2025
Intensiva Healthcare Corporation Organization, Mechanicsburg, PA For-profit 5% Or Greater Direct Ownership Interest Dec 3, 2010 100%
Christina Deblouw Individual Corporate OfficerOnsite Ceo Jun 12, 2026
W-2 Managing EmployeeOnsite Ceo Jun 12, 2026
Operational/Managerial ControlOnsite Ceo Jun 12, 2026
Jon O'Malley Individual Corporate OfficerCeo Jan 24, 2011
W-2 Managing EmployeeCeo Jan 24, 2011
Operational/Managerial ControlCeo Jan 24, 2011
John Saich Individual Corporate Officer Sep 5, 2025
Robert Breighner Individual W-2 Managing EmployeeCompliance Officer Sep 5, 2025
Michael Malatesta Individual Corporate Officer Sep 5, 2025
Robert Kido Individual Corporate Officer Sep 5, 2025
John Duggan Individual Corporate Officer Dec 3, 2010
Corporate Director Sep 5, 2025
Zaahra Butt Individual Corporate OfficerSatellite Ceo Jan 14, 2021
W-2 Managing EmployeeSatellite Ceo Jan 14, 2021
Operational/Managerial ControlSatellite Ceo Jan 14, 2021

Facilities with the same owner 129

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 129

Practitioners & affiliated clinicians

Practitioners 4

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

Affiliated clinicians 23

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757462400000",
    "number": "1912907635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4714 GETTYSBURG RD",
            "address_2": "LEGAL DEPT.",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170554325",
            "telephone_number": "717-972-1100",
            "fax_number": "717-975-9981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 NORTH AVE",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "480431716",
            "telephone_number": "586-307-9003",
            "fax_number": "586-307-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELECT SPECIALTY HOSPITAL - MACOMB COUNTY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-22",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A",
        "authorized_official_last_name": "DUGGAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "717-972-1100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "MI",
            "license": "500111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MI",
            "identifier": "00346",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3445680",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Clemens, MI

Sources for this page

Verify at the official NPI Registry.