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Organization
HOLLAND HOME
Active
Organization
HOLLAND HOME
Active
Parent organization
HOLLAND HOME
Other names
Holland Home - Fulton Manor
Organization subpart
Yes
Provider details
NPI number
Legal business name
HOLLAND HOME
Authorized official
MR. DAVID TIESENGA (CFO)
(616) 235-5035
Entity
Organization
Contact information
Practice address
1450 EAST FULTON, GRAND RAPIDS, MI 49503-3854
(616) 643-2600
(616) 643-2623
Mailing address
1450 EAST FULTON, GRAND RAPIDS, MI 49503-3854
(616) 643-2600
(616) 643-2623
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
14196
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09887
BCBS OF MICHIGAN
—
05
—
2081311
—
MI
Enumeration date
05/20/2006
Last updated
03/10/2016
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