# HAROLD AND GRACE UPJOHN COMMUNITY CARE CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** HERITAGE COMMUNITY OF KALAMAZOO
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1124002910
- **Legal business name:** HERITAGE COMMUNITY OF KALAMAZOO
- **Authorized official:** MR. DANA WHITE (ADMINISTRATOR)
- **Authorized official phone:** (269) 381-4290

## Contact information

- **Practice address:** 2400 PORTAGE ST, KALAMAZOO, MI 49001-3728
- **Practice address phone:** (269) 381-4290
- **Practice address fax:** (269) 343-5474
- **Mailing address:** 2400 PORTAGE ST, KALAMAZOO, MI 49001-3728
- **Mailing address phone:** (269) 381-4290
- **Mailing address fax:** (269) 343-5474

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 394090 | MI | Yes |

## Other

- **Enumeration date:** 12/05/2005
- **Last updated:** 01/18/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 09557 | BC BS OF MI | MI |
| 05 | — | 2081160 | — | MI |