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Organization
DEBOER, INC.
Active
Organization
DEBOER, INC.
Active
Other names
Lake Woods Nursing & Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
CONNI MCGLYNN (ADMINISTRATOR)
(231) 777-2511
Entity
Organization
Contact information
Practice address
1684 VULCAN ST, MUSKEGON, MI 49442-6070
(231) 777-2511
(231) 777-4500
Mailing address
1750 VULCAN ST, MUSKEGON, MI 49442-6048
(231) 777-2511
(231) 777-4500
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
AH610236808
MI
314000000X
Skilled Nursing Facility
Primary
614020
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4556244
—
MI
01
—
700F11095
BLUE CROSS PROVIDER NUMBER
MI
01
—
DH0255884
BLUE CROSS STATE ID
MI
01
—
P00093747
RAILROAD MEDICARE
MI
Enumeration date
12/28/2005
Last updated
09/30/2013
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