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General NPI Number Information
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NPI Number | 1093719718
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Entity Type | Organization
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Legal Business Name | ST. ANN'S HOME INC.
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 05/29/2009
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Provider Practice Location Address
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Address Line | 2161 LEONARD ST NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-3829
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Country | US
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Telephone | 616-453-7715
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Fax | 616-453-7359
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Provider Business Mailing Address
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Address Line | 2161 LEONARD ST NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-3829
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Country | US
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Telephone | 616-453-7715
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Fax | 616-453-7359
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. STEVE VERNON ROLSTON
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Credential |
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Telephone | 616-453-7715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 414270
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AH410236894
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 414270
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License Number State | MI
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