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General NPI Number Information
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NPI Number | 1801704226
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Entity Type | Organization
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Legal Business Name | FENNVILLE AL OPERATOR LLC
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Dates
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Enumeration Date | 08/28/2026
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Last Update Date | 08/28/2026
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Provider Practice Location Address
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Address Line | 2464 55TH ST
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City | FENNVILLE
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State | MI
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Zip | 49408-8448
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Country | US
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Telephone | 269-561-4663
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Fax |
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Provider Business Mailing Address
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Address Line | 21800 HAGGERTY RD STE 115
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City | NORTHVILLE
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State | MI
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Zip | 48167-9051
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE OPERATIONS SPECIALIST
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Name | JESSICA VELCHANSKY
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Credential |
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Telephone | 616-788-3469
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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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