Organization
ST. ANN'S HOME INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVE VERNON ROLSTON (ADMINISTRATOR)
(616) 453-7715
Entity
Organization
Contact information
Practice address
2161 LEONARD ST NW, GRAND RAPIDS, MI 49504-3829
(616) 453-7715
(616) 453-7359
Mailing address
2161 LEONARD ST NW, GRAND RAPIDS, MI 49504-3829
(616) 453-7715
(616) 453-7359
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
AH410236894
MI
313M00000X
Nursing Facility/Intermediate Care Facility
414270
MI
314000000X
Skilled Nursing Facility
Primary
414270
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2081385
—
MI
01
—
S9633
BLUE CROSS MEDICARE SUPPLEMENTAL
MI
Enumeration date
06/10/2005
Last updated
05/29/2009
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