=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396016796
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHVIEW CARE CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2012
-----------------------------------------------------
Last Update Date | 01/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3740 RICHTON AVE NE
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49525-2463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-364-4690
-----------------------------------------------------
Fax | 616-364-4615
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3740 RICHTON AVE NE
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49525-2463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-364-4690
-----------------------------------------------------
Fax | 616-364-4615
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES.
-----------------------------------------------------
Name | SCOTT GRAVES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 616-364-4690
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL410007147
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 311500000X
-----------------------------------------------------
Taxonomy Name | Alzheimer Center (Dementia Center)
-----------------------------------------------------
License Number | AL410007164
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL410007146
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------