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General NPI Number Information
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NPI Number | 1144769506
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Entity Type | Organization
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Legal Business Name | RESOLUTE ADULT LIVING FACILITY
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Dates
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Enumeration Date | 02/18/2017
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Last Update Date | 02/18/2017
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Provider Practice Location Address
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Address Line | 1414 EASTERN AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-2024
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Country | US
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Telephone | 616-243-4696
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Fax | 616-243-4695
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Provider Business Mailing Address
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Address Line | 1414 EASTERN AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49507-2024
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Country | US
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Telephone | 616-243-4696
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Fax | 616-243-4695
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Authorized Official
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Title or Position | LICENSEE
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Name | LISA TILLMAN
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Credential |
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Telephone | 616-243-4696
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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 | AS410363656
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License Number State | MI
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