Provider Demographics
NPI:1114532736
Name:RETIREMENT LIVING MANAGEMENT OF GAYLORD L.L.C.
Entity Type:Organization
Organization Name:RETIREMENT LIVING MANAGEMENT OF GAYLORD L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ONWELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-705-2500
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 1:1261 VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-9195
Practice Address - Country:US
Practice Address - Phone:989-705-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAL690095753OtherAFC LICENSE
MIAL690095752OtherAFC LICENSE