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General NPI Number Information
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NPI Number | 1124454053
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Entity Type | Organization
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Legal Business Name | GRAND PINES 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 | 1410 S FERRY ST
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2711
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Country | US
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Telephone | 616-850-2150
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Fax | 616-850-2158
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Provider Business Mailing Address
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Address Line | 1410 S FERRY ST
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2711
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Country | US
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Telephone | 616-850-2150
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Fax | 616-850-2158
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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 | AH700299440
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License Number State | MI
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