Basic Information
Provider Information
NPI: 1568460939
EntityType: 2
ReplacementNPI:  
OrganizationName: ATRIUM FREEMAN, LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: FREEMAN NURSING AND REHABILITATION COMMUNITY
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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: 1805 W PYLE DR
Address2:  
City: KINGSFORD
State: MI
PostalCode: 498024258
CountryCode: US
TelephoneNumber: 9067741530
FaxNumber: 9067744971
Other Information
ProviderEnumerationDate: 07/11/2005
LastUpdateDate: 11/01/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LOCKHART
AuthorizedOfficialFirstName: DENNIS
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CHIEF ACCOUNTING OFFICER
AuthorizedOfficialTelephone: 6144160600
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/01/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X22-4010MIY Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

ID Information
IDTypeStateIssuerDescription
0981501MIBCBS PROVIDER CODEOTHER
60 445149405MI MEDICAID


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