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General NPI Number Information
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NPI Number | 1548537103
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Entity Type | Organization
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Legal Business Name | REST HAVEN HOMES INC
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 1424 UNION AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-5197
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Country | US
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Telephone | 616-363-6819
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Fax | 616-363-1658
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Provider Business Mailing Address
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Address Line | 1424 UNION NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-5197
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Country | US
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Telephone | 616-363-6819
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Fax | 616-363-1658
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Authorized Official
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Title or Position | ADMINISTRATOR OF FINANCE
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Name | TERRY RUTH CARRICK
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Credential | NHA
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Telephone | 616-363-6819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 1070000412
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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 | AH410236876
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License Number State | MI
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