| NPI | 1417398595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL JAY MODDERMAN Designee 616-334-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: MI AS700321868) |
| Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities (Licence: MI AS700321868) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2013-07-18 |