Healthcare Provider Details

I. General information

NPI: 1801704226
Provider Name (Legal Business Name): FENNVILLE AL OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2464 55TH ST
FENNVILLE MI
49408-8448
US

IV. Provider business mailing address

21800 HAGGERTY RD STE 115
NORTHVILLE MI
48167-9051
US

V. Phone/Fax

Practice location:
  • Phone: 269-561-4663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JESSICA VELCHANSKY
Title or Position: EXECUTIVE OPERATIONS SPECIALIST
Credential:
Phone: 616-788-3469