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PINE RIDGE ADULT CARE HOME LLC NPI 1730514290


NPI Information

NPI: 1730514290
Provider Name: PINE RIDGE ADULT CARE HOME, LLC

Doing Business As: PINE RIDGE ASSISTED LIVING FACILITY

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 23D2074048

Address:
15467 PORT SHELDON ST
WEST OLIVE, MI
ZIP 49460
Phone: (616) 399-1774
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PINE RIDGE ADULT CARE HOME, LLC is an assisted living facility in West Olive, MI. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. PINE RIDGE ADULT CARE HOME, LLC NPI is 1730514290. The provider is registered as an organization entity type.
The provider Is Doing Business As Pine Ridge Assisted Living Facility.

The provider's business location address is:

15467 PORT SHELDON ST
WEST OLIVE, MI
ZIP 49460-715
Phone: (616) 399-1774
Fax: (616) 738-0009

The provider's authorized official is Debra Ann Westerhof .
The authorized official title is Licensee and has the following contact phone number (616) 399-1774.

The CLIA number assigned to this NPI record is 23D2074048 - other - adult foster care with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/3/2013 and was last updated on 9/3/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living FacilityAL700079149MICHIGANYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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