Organization
SOUTH COAST HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHESTER KWIATKOWSKI (LICENSEE/OWNER)
(269) 998-9349
Entity
Organization
Contact information
Practice address
72633 M 43, SOUTH HAVEN, MI 49090-8734
(269) 998-9349
Mailing address
PO BOX 29, MACATAWA, MI 49434-0029
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/25/2019
Last updated
02/26/2024
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