Healthcare Provider Details

I. General information

NPI: 1578739827
Provider Name (Legal Business Name): ST ANN'S HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 LEONARD NW
GRAND RAPIDS MI
49504
US

IV. Provider business mailing address

3683 MAPLEBROOK DR NW
GRAND RAPIDS MI
49534-2709
US

V. Phone/Fax

Practice location:
  • Phone: 616-453-7715
  • Fax: 616-735-0633
Mailing address:
  • Phone: 616-735-1513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5201006651
License Number StateMI

VIII. Authorized Official

Name: MRS. KAREN FARHAT-HENDRICKS
Title or Position: OCCUPATIONAL THERAPIST REGISTERED
Credential: OTR
Phone: 616-735-1513