Basic Information
| Provider Information | |||||||||
| NPI: | 1487727277 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HPCN | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HARBORWOOD AT THE LAKES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6401 PRAIRIE ST | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494447840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317277920 | ||||||||
| FaxNumber: | 2317277921 | ||||||||
| Practice Location | |||||||||
| Address1: | 6401 PRAIRIE ST | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494447840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317277920 | ||||||||
| FaxNumber: | 2317277921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SNYDER | ||||||||
| AuthorizedOfficialFirstName: | JUDY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2317285033 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.