# HOLLAND HOME

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** HOLLAND HOME
- **Other names:** Holland Home - Raybrook Manor
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1396799987
- **Legal business name:** HOLLAND HOME
- **Authorized official:** MR. ADAM KINDER (CFO)
- **Authorized official phone:** (616) 235-5015

## Contact information

- **Practice address:** 2121 RAYBROOK ST SE, GRAND RAPIDS, MI 49546-5793
- **Practice address phone:** (616) 235-5002
- **Practice address fax:** (616) 235-5088
- **Mailing address:** 2121 RAYBROOK ST SE, GRAND RAPIDS, MI 49546-5793
- **Mailing address phone:** (616) 235-5002
- **Mailing address fax:** (616) 235-5088

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 14208 | MI | Yes |

## Other

- **Enumeration date:** 05/19/2006
- **Last updated:** 04/29/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 09891 | BCBS OF MICHIGAN | — |
| 05 | — | 2084260 | — | MI |