Organization
REST HAVEN ILLIANA CHRISTIAN CONVELESCENT HOME
Active
Other names
Providence at Home
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN JOHNSON (VICE PRESIDENT)
(708) 342-8126
Entity
Organization
Contact information
Practice address
500 PARKSIDE DR, SUITE 159, ZEELAND, MI 49464-2056
(616) 772-2935
(616) 772-9998
Mailing address
500 PARKSIDE DR, SUITE 159, ZEELAND, MI 49464-2056
(616) 772-2935
(616) 772-9998
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
10/22/2008
Last updated
10/22/2008
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