# GRACEWAY SOUTH HAVEN, LLC

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

## Provider details

- **NPI number:** 1295208882
- **Authorized official:** ANTHONY FISCHER (CEO)
- **Authorized official phone:** (734) 624-4887

## Contact information

- **Practice address:** 120 BASELINE RD, SOUTH HAVEN, MI 49090-1037
- **Practice address phone:** (269) 637-8411
- **Mailing address:** 1001 WOODWARD AVE FL 5, DETROIT, MI 48226-1904

## Taxonomy

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

## Other

- **Enumeration date:** 01/07/2019
- **Last updated:** 01/07/2019