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General NPI Number Information
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NPI Number | 1770435455
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Entity Type | Organization
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Legal Business Name | PORTER HILLS PRESBYTERIAN VILLAGE, INC.
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Dates
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Enumeration Date | 02/13/2026
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 3600 FULTON ST E
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-1322
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Country | US
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Telephone | 616-949-4971
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 FULTON ST E
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-1322
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Country | US
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Telephone | 616-949-4971
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Fax |
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Authorized Official
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Title or Position | CHIEF OF RESIDENTIAL SERVICES
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Name | NICOLE LYNN MAAG
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Credential | RN, NHA, CALD, COS
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Telephone | 616-460-9441
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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 |
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License Number State |
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