Organization
WILDS RIVER REST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANICE ELLEN WILDS (OWNER)
(269) 695-6074
Entity
Organization
Contact information
Practice address
12409 N RED BUD TRL, BUCHANAN, MI 49107-9139
(269) 695-6074
(269) 697-0474
Mailing address
12409 N RED BUD TRL, BUCHANAN, MI 49107-9139
(269) 695-6074
(269) 697-0474
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AM110064771
MI
311Z00000X
Custodial Care Facility
AM110064771
MI
Other
Enumeration date
10/01/2013
Last updated
10/01/2013
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