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General NPI Number Information
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NPI Number | 1144147364
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Entity Type | Organization
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Legal Business Name | KC ASSISTED LIVING CORPORATION
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Dates
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Enumeration Date | 06/30/2026
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Last Update Date | 06/30/2026
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Provider Practice Location Address
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Address Line | 7884 EMERY RD
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City | PORTLAND
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State | MI
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Zip | 48875-8727
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Country | US
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Telephone | 517-719-9334
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Fax |
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Provider Business Mailing Address
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Address Line | 7884 EMERY RD
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City | PORTLAND
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State | MI
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Zip | 48875-8727
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Country | US
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Telephone | 517-719-9334
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Fax |
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Authorized Official
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Title or Position | OWNER/RN
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Name | COURTNEY SHAFER
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Credential |
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Telephone | 517-719-9334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number |
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License Number State |
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