Healthcare Provider Details

I. General information

NPI: 1033287792
Provider Name (Legal Business Name): HOLLAND HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 RAYBROOK ST SE SUITE 300
GRAND RAPIDS MI
49546-5783
US

IV. Provider business mailing address

2100 RAYBROOK ST SE SUITE 300
GRAND RAPIDS MI
49546-5783
US

V. Phone/Fax

Practice location:
  • Phone: 616-235-5000
  • Fax: 616-235-5680
Mailing address:
  • Phone: 616-235-5000
  • Fax: 616-235-5680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID TIESENGA
Title or Position: CFO
Credential:
Phone: 616-235-5035