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General NPI Number Information
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NPI Number | 1972848042
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Entity Type | Organization
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Legal Business Name | HEATHER HILLS NURSING, LLC
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Dates
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Enumeration Date | 11/30/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1157 MEDICAL PARK DR SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-3686
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Country | US
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Telephone | 616-949-7310
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Fax | 616-956-0973
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Provider Business Mailing Address
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Address Line | 954 RIDGEBROOK RD STE 130
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City | SPARKS
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State | MD
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Zip | 21152-9469
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Country | US
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Telephone | 410-387-0155
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Fax | 502-213-9977
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Authorized Official
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Title or Position | CEO
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Name | BRETTON J BOLT
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Credential |
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Telephone | 301-991-1388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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