Healthcare Provider Details

I. General information

NPI: 1396016796
Provider Name (Legal Business Name): NORTHVIEW CARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 RICHTON AVE NE
GRAND RAPIDS MI
49525-2463
US

IV. Provider business mailing address

3740 RICHTON AVE NE
GRAND RAPIDS MI
49525-2463
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-4690
  • Fax: 616-364-4615
Mailing address:
  • Phone: 616-364-4690
  • Fax: 616-364-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL410007147
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberAL410007164
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL410007146
License Number StateMI

VIII. Authorized Official

Name: SCOTT GRAVES
Title or Position: PRES.
Credential:
Phone: 616-364-4690