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CAH231322-09 MUNSON HEALTHCARE CHARLEVOIX HOSPITAL (Active)
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Main Details
Name
MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Subdivision Name
Munson Healthcare Charlevoix Behavioral Health - Behavioral Health Services
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH231322-09
Medicare Provider Number
231322
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/6/2020
Participating Start Date
4/1/2020
Participating Approval Date
1/8/2020
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Munson Healthcare
Kathleen M LaRaia, Vice President
(231) 392-8410
Primary Contact
Munson Healthcare
Sam Patrick Niemi, System Director Reimbursement
(231) 935-7761
Addresses
Street Address
14695 Park Ave
Ste. B
Charlevoix, MI 49720
Billing Address
Munson Healthcare Charlevoix Hospital
14700 Lake Shore Drive
Charlevoix, MI 49720
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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