Healthcare Provider Details

I. General information

NPI: 1114130499
Provider Name (Legal Business Name): PORTER HILLS RETIREMENT COMMUNITIES & SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4450 CASCADE RD SE SUITE 300
GRAND RAPIDS MI
49546-8330
US

IV. Provider business mailing address

4450 CASCADE RD SE SUITE 300
GRAND RAPIDS MI
49546-8330
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-5140
  • Fax: 616-575-5123
Mailing address:
  • Phone: 616-949-5140
  • Fax: 616-575-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERESA TOLAND
Title or Position: DIRECTOR
Credential: RN
Phone: 616-949-5140