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General NPI Number Information
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NPI Number | 1043646979
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Entity Type | Organization
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Legal Business Name | SEMINOLE SHORES OPERATING COMPANY
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Dates
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Enumeration Date | 09/24/2013
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 850 SEMINOLE RD
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City | NORTON SHORES
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State | MI
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Zip | 49441-4340
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Country | US
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Telephone | 231-780-2944
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Fax | 231-780-2599
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Provider Business Mailing Address
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Address Line | 850 SEMINOLE RD
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City | NORTON SHORES
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State | MI
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Zip | 49441-4340
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Country | US
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Telephone | 231-780-2944
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Fax | 231-780-2599
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Authorized Official
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Title or Position | AUTHORIZED AGENT
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Name | MR. SCOTT A REENDERS
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Credential |
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Telephone | 616-842-2425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AH610255010
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License Number State | MI
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