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General NPI Number Information
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NPI Number | 1841176260
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Entity Type | Organization
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Legal Business Name | GRACE HAVEN SENIOR LIVING LLC
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 5191 N 41 1/2 RD
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City | MANTON
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State | MI
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Zip | 49663-9763
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Country | US
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Telephone | 231-631-2689
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Fax | 231-824-7771
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Provider Business Mailing Address
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Address Line | 5191 N 41 1/2 RD
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City | MANTON
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State | MI
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Zip | 49663-9763
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Country | US
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Telephone | 231-631-2689
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Fax | 231-824-7771
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SHELBY L MACK
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Credential |
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Telephone | 231-631-2689
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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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