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General NPI Number Information
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NPI Number | 1528395258
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Entity Type | Organization
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Legal Business Name | GRACE HAVEN ASSISTED LIVING
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Dates
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Enumeration Date | 11/18/2009
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 1507 GLASTONBURY DR
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City | SAINT JOHNS
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State | MI
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Zip | 48879-8235
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Country | US
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Telephone | 989-224-1650
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Fax |
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Provider Business Mailing Address
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Address Line | 3196 KRAFT AVE SE SUITE 200
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City | GRAND RAPIDS
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State | MI
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Zip | 49512-2078
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Country | US
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Telephone | 616-464-1564
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | CYNDI MCDONALD
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Credential |
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Telephone | 989-224-1650
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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 | AL190294006
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL190294037
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License Number State | MI
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