Basic Information
| Provider Information | |||||||||
| NPI: | 1225036395 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATRIUM GLADWIN INC. | ||||||||
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| OtherOrganizationName: | GLADWIN NURSING AND REHABILITATION COMMUNITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 HAKES DR | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | NORTON SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494415574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317996870 | ||||||||
| FaxNumber: | 2317990250 | ||||||||
| Practice Location | |||||||||
| Address1: | 3270 PRATT LAKE RD | ||||||||
| Address2: | |||||||||
| City: | GLADWIN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486248901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894267275 | ||||||||
| FaxNumber: | 9894268666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 02/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | LOCKHART | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF ACCOUNTING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6144160600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 26-4020 | MI | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 60 3425426 | 05 | MI | MEDICAID | 09824 | 01 | MI | BCBS PROVIDER CODE | OTHER |