# SAMARITAS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Lodge at MapleCreek
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750374914
- **Authorized official:** JENNY CEDERSTROM (CFO)
- **Authorized official phone:** (313) 823-7700

## Contact information

- **Practice address:** 1950 32ND ST SE, GRAND RAPIDS, MI 49508-7909
- **Practice address phone:** (616) 452-5900
- **Practice address fax:** (616) 452-4271
- **Mailing address:** 8131 E JEFFERSON AVE, DETROIT, MI 48214-2610
- **Mailing address phone:** (313) 823-7700
- **Mailing address fax:** (313) 823-9604

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 414021 | MI | Yes |

## Other

- **Enumeration date:** 08/23/2005
- **Last updated:** 01/25/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 09890 | BCBS | MI |
| 05 | — | 2150464 | — | MI |