Provider Demographics
NPI:1033653415
Name:RETIREMENT LIVING MANAGEMENT OF ALLENDALE L.L.C
Entity Type:Organization
Organization Name:RETIREMENT LIVING MANAGEMENT OF ALLENDALE L.L.C
Other - Org Name:GREEN ACRES OF ALLENDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-892-1200
Mailing Address - Street 1:11289 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49401-8222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11289 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:MI
Practice Address - Zip Code:49401-8222
Practice Address - Country:US
Practice Address - Phone:616-892-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL700380147310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility