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General NPI Number Information
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NPI Number | 1508605221
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Entity Type | Organization
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Legal Business Name | NEW HAVEN ASSISTED LIVING INC
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 231 4TH ST
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City | LAKEVIEW
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State | MI
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Zip | 48850-5024
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Country | US
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Telephone | 616-307-7719
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Fax |
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Provider Business Mailing Address
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Address Line | 4364 LITTLE CREEK CT
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City | CEDAR SPRINGS
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State | MI
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Zip | 49319-7918
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Country | US
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Telephone | 616-307-7719
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHAEL JOHN DYKSTRA
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Credential |
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Telephone | 616-307-7719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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