Provider Demographics
NPI:1114532017
Name:RETIREMENT LIVING MANAGEMENT OF TAWAS LLC
Entity Type:Organization
Organization Name:RETIREMENT LIVING MANAGEMENT OF TAWAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBER-THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-362-8420
Mailing Address - Street 1:1845 BIRMINGHAM
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331-8664
Mailing Address - Country:US
Mailing Address - Phone:616-897-8000
Mailing Address - Fax:
Practice Address - Street 1:910 N TAWAS LAKE RD
Practice Address - Street 2:
Practice Address - City:EAST TAWAS
Practice Address - State:MI
Practice Address - Zip Code:48730-9699
Practice Address - Country:US
Practice Address - Phone:989-362-8420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIXH350402114OtherHOME FOR THE AGED LICENSURE