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General NPI Number Information
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NPI Number | 1174577761
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Entity Type | Organization
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Legal Business Name | HOLLAND HOME
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 2589 44TH STREET
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City | KENTWOOD
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State | MI
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Zip | 49512-3877
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Country | US
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Telephone | 616-235-2500
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Fax | 616-235-2514
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Provider Business Mailing Address
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Address Line | 2589 44TH STREET
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City | KENTWOOD
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State | MI
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Zip | 49512-3877
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Country | US
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Telephone | 616-235-2500
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Fax | 616-235-2514
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Authorized Official
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Title or Position | CFO
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Name | MR. ADAM KINDER
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Credential |
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Telephone | 616-235-5015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 14117
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License Number State | MI
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