Healthcare Provider Details

I. General information

NPI: 1548537103
Provider Name (Legal Business Name): REST HAVEN HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 UNION AVE NE
GRAND RAPIDS MI
49505-5197
US

IV. Provider business mailing address

1424 UNION NE
GRAND RAPIDS MI
49505-5197
US

V. Phone/Fax

Practice location:
  • Phone: 616-363-6819
  • Fax: 616-363-1658
Mailing address:
  • Phone: 616-363-6819
  • Fax: 616-363-1658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAH410236876
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1070000412
License Number StateMI

VIII. Authorized Official

Name: TERRY RUTH CARRICK
Title or Position: ADMINISTRATOR OF FINANCE
Credential: NHA
Phone: 616-363-6819