MEDICARE: HEATHER HILLS LIMITED PARTNERSHIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	414370	MI

General Provider Information

NPI Number	:	1891792735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEATHER HILLS LIMITED PARTNERSHIP

Provider Business Mailing Address
First Line	:	1157 MEDICAL PARK DR SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3699
Country	:	US
Telephone Number	:	616-949-7310
Fax Number	:	616-956-0973

Provider Business Practice Location Address
First Line	:	1157 MEDICAL PARK DR SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3699
Country	:	US
Telephone Number	:	616-949-7310
Fax Number	:	616-956-0973

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. MICHAEL LEE DOCKHAM
Credential	:	NHA
Telephone Number	:	616-949-7310

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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