Provider Demographics
NPI:1265646095
Name:WOODLAWN MEADOWS RETIREMENT VILLAGE
Entity Type:Organization
Organization Name:WOODLAWN MEADOWS RETIREMENT VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:POORTENGA
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:269-948-4921
Mailing Address - Street 1:1821 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1367
Mailing Address - Country:US
Mailing Address - Phone:269-948-4921
Mailing Address - Fax:269-948-4922
Practice Address - Street 1:1821 N EAST ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-1367
Practice Address - Country:US
Practice Address - Phone:269-948-4921
Practice Address - Fax:269-948-4922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory