Healthcare Provider Details

I. General information

NPI: 1972848042
Provider Name (Legal Business Name): HEATHER HILLS NURSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 MEDICAL PARK DR SE
GRAND RAPIDS MI
49546-3686
US

IV. Provider business mailing address

954 RIDGEBROOK RD STE 130
SPARKS MD
21152-9469
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-7310
  • Fax: 616-956-0973
Mailing address:
  • Phone: 410-387-0155
  • Fax: 502-213-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BRETTON J BOLT
Title or Position: CEO
Credential:
Phone: 301-991-1388