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General NPI Number Information
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NPI Number | 1891150330
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Entity Type | Organization
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Legal Business Name | CHERRY SUITE ASSISTED LIVING
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 12/29/2015
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Provider Practice Location Address
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Address Line | 10774 S US HIGHWAY 31
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City | WILLIAMSBURG
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State | MI
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Zip | 49690-9419
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Country | US
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Telephone | 231-534-5055
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Fax |
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Provider Business Mailing Address
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Address Line | 10774 S US HIGHWAY 31
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City | WILLIAMSBURG
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State | MI
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Zip | 49690-9419
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Country | US
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Telephone | 231-534-5055
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MICHELE LYNN ULRICH
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Credential | LPN
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Telephone | 231-534-5055
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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 | AM050320275
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License Number State | MI
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