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General NPI Number Information
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NPI Number | 1639487754
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Entity Type | Organization
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Legal Business Name | WOODLAWN MEADOWS RETIREMENT VILLAGE, LLC
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 1821 N EAST ST
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City | HASTINGS
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State | MI
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Zip | 49058-1367
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Country | US
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Telephone | 269-948-4921
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Fax |
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Provider Business Mailing Address
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Address Line | 1821 N EAST ST
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City | HASTINGS
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State | MI
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Zip | 49058-1367
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Country | US
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Telephone | 269-948-4921
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THOMAS NOBEL
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Credential |
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Telephone | 269-948-4921
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 23D1046098
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License Number State | MI
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