Healthcare Provider Details

I. General information

NPI: 1467384099
Provider Name (Legal Business Name): MAPLE RIDGE MANOR OF LOWELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12020 FOREMAN ST
LOWELL MI
49331-1029
US

IV. Provider business mailing address

12020 FOREMAN ST
LOWELL MI
49331-1029
US

V. Phone/Fax

Practice location:
  • Phone: 616-552-1588
  • Fax: 616-552-1548
Mailing address:
  • Phone: 616-552-1588
  • Fax: 616-552-1548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER MARIE KRAMER
Title or Position: ADMINISTRATOR
Credential: RMA ADMINISTRATOR
Phone: 616-552-1588