# CLARK RETIREMENT COMMUNITY, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265421051
- **Authorized official:** MR. BRIAN A PANGLE (PRESIDENT/CEO)
- **Authorized official phone:** (616) 452-1568

## Contact information

- **Practice address:** 1551 FRANKLIN ST SE, GRAND RAPIDS, MI 49506
- **Practice address phone:** (616) 452-1568
- **Practice address fax:** (616) 247-9625
- **Mailing address:** 1551 FRANKLIN ST SE, GRAND RAPIDS, MI 49506
- **Mailing address phone:** (616) 452-1568
- **Mailing address fax:** (616) 247-9625

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 235401 | MI | Yes |

## Other

- **Enumeration date:** 10/14/2005
- **Last updated:** 04/07/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2081269 | — | MI |