Healthcare Provider Details

I. General information

NPI: 1306372396
Provider Name (Legal Business Name): HOLTON MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 FRANCIS AVE SE
GRAND RAPIDS MI
49507-3016
US

IV. Provider business mailing address

304 MADISON AVE SE
GRAND RAPIDS MI
49503-4618
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-9331
  • Fax: 616-459-9331
Mailing address:
  • Phone: 616-459-9331
  • Fax: 616-459-9331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAS410261725
License Number StateMI

VIII. Authorized Official

Name: JESSICA LOUISE ADAMS
Title or Position: VICE PRESIDENT
Credential:
Phone: 616-459-9331