Organization
CLARK RETIREMENT COMMUNITY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN A PANGLE (PRESIDENT/CEO)
(616) 452-1568
Entity
Organization
Contact information
Practice address
1551 FRANKLIN ST SE, GRAND RAPIDS, MI 49506
(616) 452-1568
(616) 247-9625
Mailing address
1551 FRANKLIN ST SE, GRAND RAPIDS, MI 49506
(616) 452-1568
(616) 247-9625
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
235401
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2081269
—
MI
Enumeration date
10/14/2005
Last updated
04/07/2015
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