Healthcare Provider Details

I. General information

NPI: 1235479767
Provider Name (Legal Business Name): MARYWOOD HEALTH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LAKESIDE DR NE
GRAND RAPIDS MI
49503-3811
US

IV. Provider business mailing address

4450 CASCADE RD SE STE 200
GRAND RAPIDS MI
49546-8330
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-1993
  • Fax: 616-454-6105
Mailing address:
  • Phone: 616-949-4975
  • Fax: 616-954-1795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA MCMICHAEL
Title or Position: NURSING HOME ADMINISTRATOR
Credential:
Phone: 616-490-2942