Healthcare Provider Details

I. General information

NPI: 1659913465
Provider Name (Legal Business Name): MS CASCADE HS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 CHARLEVOIX DR SE
GRAND RAPIDS MI
49546-7035
US

IV. Provider business mailing address

3041 CHARLEVOIX DR SE
GRAND RAPIDS MI
49546-7035
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-7200
  • Fax: 616-942-7203
Mailing address:
  • Phone: 616-942-7200
  • Fax: 616-942-7203

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: MAZIE PILUT
Title or Position: DIRECTOR OF OPERTIONS
Credential:
Phone: 616-942-7200