Provider Demographics
NPI:1316552888
Name:RETIREMENT LIVING MANAGEMENT OF MANISTEE L.L.C.
Entity Type:Organization
Organization Name:RETIREMENT LIVING MANAGEMENT OF MANISTEE L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-723-1000
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 1:1835 12TH ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-8967
Practice Address - Country:US
Practice Address - Phone:231-723-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAM510385374OtherAFC LICENSE
MIAL510256121OtherAFC LICENSE