Healthcare Provider Details

I. General information

NPI: 1396799987
Provider Name (Legal Business Name): HOLLAND HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 RAYBROOK ST SE
GRAND RAPIDS MI
49546-5793
US

IV. Provider business mailing address

2121 RAYBROOK ST SE
GRAND RAPIDS MI
49546-5793
US

V. Phone/Fax

Practice location:
  • Phone: 616-235-5002
  • Fax: 616-235-5088
Mailing address:
  • Phone: 616-235-5002
  • Fax: 616-235-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number14208
License Number StateMI

VIII. Authorized Official

Name: MR. ADAM KINDER
Title or Position: CFO
Credential:
Phone: 616-235-5015