Organization
GRACE HAVEN ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNDI MCDONALD (ADMINISTRATOR)
(989) 224-1650
Entity
Organization
Contact information
Practice address
1507 GLASTONBURY DR, SAINT JOHNS, MI 48879-8235
(989) 224-1650
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
AL190294006
MI
310400000X
Assisted Living Facility
Primary
AL190294037
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23D1102195
CLIA
MI
Enumeration date
11/18/2009
Last updated
11/18/2009
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