# COVENANT LIVING OF THE GREAT LAKES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Covenant Living of the Great Lakes
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568554566
- **Authorized official:** ELIZABETH MCLAREN (ASSOCIATE VICE PRESIDENT OF HEALTH)
- **Authorized official phone:** (773) 878-4430

## Contact information

- **Practice address:** 2520 LAKE MICHIGAN DRIVE NW, GRAND RAPIDS, MI 49504-4696
- **Practice address phone:** (616) 735-4541
- **Practice address fax:** (616) 735-5900
- **Mailing address:** 2520 LAKE MICHIGAN DRIVE NW, GRAND RAPIDS, MI 49504-4696
- **Mailing address phone:** (616) 735-4541
- **Mailing address fax:** (616) 735-5900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 414382 | MI | Yes |

## Other

- **Enumeration date:** 09/28/2006
- **Last updated:** 01/28/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 7974902 | — | MI |