Organization
FOREST GLEN ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY HANER (ADMINISTRATOR)
(269) 782-5300
Entity
Organization
Contact information
Practice address
29601 AMERIHOST DR, DOWAGIAC, MI 49047-8320
(269) 782-5300
Mailing address
3196 KRAFT AVE SE, SUITE 200, GRAND RAPIDS, MI 49512-2078
(616) 464-1564
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL40280138
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23D1102204
CLIA
MI
Enumeration date
11/17/2009
Last updated
03/09/2015
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