Organization
SPRING LAKE COMPASSIONATE LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL JAY MODDERMAN (DESIGNEE)
(616) 334-6262
Entity
Organization
Contact information
Practice address
16609 VILLA PKWY, SPRING LAKE, MI 49456-8835
(616) 414-5006
Mailing address
16609 VILLA PKWY, SPRING LAKE, MI 49456-8835
(616) 414-5006
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AS700321868
MI
320700000X
Physical Disabilities Residential Treatment Facility
AS700321868
MI
Other
Enumeration date
07/17/2013
Last updated
07/18/2013
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