Organization
GRANDHAVEN LIVING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMANTHA THELEN (ADMINISTRATOR)
(517) 485-5966
Entity
Organization
Contact information
Practice address
3145 W MOUNT HOPE AVE, LANSING, MI 48911-1665
(517) 485-5966
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
AL330237775
MI
310400000X
Assisted Living Facility
AL330237781
MI
310400000X
Assisted Living Facility
AL330267336
MI
310400000X
Assisted Living Facility
AL330268975
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23D1102203
CLIA
MI
Enumeration date
11/17/2009
Last updated
03/06/2015
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