Healthcare Provider Details

I. General information

NPI: 1679740633
Provider Name (Legal Business Name): ST. ANN'S HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2161 LEONARD ST NW
GRAND RAPIDS MI
49504-3829
US

IV. Provider business mailing address

4259 CROOKED TREE RD SW APT 11
WYOMING MI
49519-5265
US

V. Phone/Fax

Practice location:
  • Phone: 616-453-7715
  • Fax:
Mailing address:
  • Phone: 517-256-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. JILL ADAMS
Title or Position: SPEECH THERAPIST
Credential: SLP
Phone: 616-453-7715