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NPI Code Detail

MEDICARE: ST. ANN'S HOME INC.

MEDICARE: ST. ANN'S HOME INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1313M00000XNursing Facility/Intermediate Care Facility414270MI
2310400000XAssisted Living FacilityAH410236894MI
3314000000XSkilled Nursing Facility414270MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2S9633OTHERMIBLUE CROSS MEDICARE SUPPLEMENTAL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093719718
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. ANN'S HOME INC.
Provider Business Mailing Address
First Line : 2161 LEONARD ST NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-3829
Country : US
Telephone Number : 616-453-7715
Fax Number : 616-453-7359
Provider Business Practice Location Address
First Line : 2161 LEONARD ST NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-3829
Country : US
Telephone Number : 616-453-7715
Fax Number : 616-453-7359
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. STEVE VERNON ROLSTON
Credential :
Telephone Number : 616-453-7715
Provider Enumeration Date : 06/10/2005
Last Update Date : 05/29/2009

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