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General NPI Number Information
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NPI Number | 1114353059
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Entity Type | Organization
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Legal Business Name | RAILSIDE ASSISTED LIVING CENTER
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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 | 7955 BYRON CENTER AVE SW
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City | BYRON CENTER
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State | MI
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Zip | 49315-8867
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Country | US
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Telephone | 616-878-4620
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Fax | 616-878-5338
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Provider Business Mailing Address
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Address Line | 7955 BYRON CENTER AVE SW
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City | BYRON CENTER
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State | MI
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Zip | 49315-8867
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Country | US
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Telephone | 616-878-4620
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Fax | 616-878-5338
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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 | AH410236873
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License Number State | MI
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