Organization
SAMARITAS
Active
Other names
The Lodge at MapleCreek
Organization subpart
No
Provider details
NPI number
Authorized official
JENNY CEDERSTROM (CFO)
(313) 823-7700
Entity
Organization
Contact information
Practice address
1950 32ND ST SE, GRAND RAPIDS, MI 49508-7909
(616) 452-5900
(616) 452-4271
Mailing address
8131 E JEFFERSON AVE, DETROIT, MI 48214-2610
(313) 823-7700
(313) 823-9604
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
414021
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09890
BCBS
MI
05
—
2150464
—
MI
Enumeration date
08/23/2005
Last updated
01/25/2017
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