Provider Demographics
NPI:1003281213
Name:RETIREMENT LIVING MANAGEMENT OF WAYLAND
Entity Type:Organization
Organization Name:RETIREMENT LIVING MANAGEMENT OF WAYLAND
Other - Org Name:GREEN ACRES OF WAYLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSENTOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-792-1500
Mailing Address - Street 1:298 KAY LN
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-9181
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:298 KAY LN
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-9181
Practice Address - Country:US
Practice Address - Phone:269-792-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL030366248310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility