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General NPI Number Information
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NPI Number | 1174951446
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Entity Type | Organization
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Legal Business Name | RETIREMENT LIVING MANAGEMENT OF LOWELL
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Dates
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Enumeration Date | 10/24/2013
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Last Update Date | 10/24/2013
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Provider Practice Location Address
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Address Line | 11530 FULTON ST E
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City | LOWELL
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State | MI
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Zip | 49331-9609
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Country | US
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Telephone | 616-987-9115
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Fax | 616-987-9122
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Provider Business Mailing Address
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Address Line | 11530 FULTON ST E
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City | LOWELL
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State | MI
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Zip | 49331-9609
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Country | US
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Telephone | 616-987-9115
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Fax | 616-987-9122
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KELLY JOHNSON
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Credential |
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Telephone | 616-987-9115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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License Number | AL410311105
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License Number State | MI
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