Healthcare Provider Details

I. General information

NPI: 1770435455
Provider Name (Legal Business Name): PORTER HILLS PRESBYTERIAN VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 FULTON ST E
GRAND RAPIDS MI
49546-1322
US

IV. Provider business mailing address

3600 FULTON ST E
GRAND RAPIDS MI
49546-1322
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-4971
  • Fax:
Mailing address:
  • Phone: 616-949-4971
  • Fax:

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: NICOLE LYNN MAAG
Title or Position: CHIEF OF RESIDENTIAL SERVICES
Credential: RN, NHA, CALD, COS
Phone: 616-460-9441