Provider Demographics
NPI:1245572346
Name:PORTER HILLS PRESBYTERIAN VILLAGE, INC.
Entity Type:Organization
Organization Name:PORTER HILLS PRESBYTERIAN VILLAGE, INC.
Other - Org Name:MARYWOOD HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-490-2942
Mailing Address - Street 1:4450 CASCADE RD SE
Mailing Address - Street 2:STE 200
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8330
Mailing Address - Country:US
Mailing Address - Phone:616-949-4975
Mailing Address - Fax:616-954-1795
Practice Address - Street 1:111 LAKESIDE DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3811
Practice Address - Country:US
Practice Address - Phone:616-456-1993
Practice Address - Fax:616-454-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility