Provider Demographics
NPI:1326013830
Name:PORTER HILLS PRESBYTERIAN VILLAGE, INC.
Entity Type:Organization
Organization Name:PORTER HILLS PRESBYTERIAN VILLAGE, INC.
Other - Org Name:PORTER HILLS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF RESIDENTIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MAAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-460-9441
Mailing Address - Street 1:4450 CASCADE ROAD SE
Mailing Address - Street 2:SUITE 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 1:3600 E FULTON STREET
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-1322
Practice Address - Country:US
Practice Address - Phone:616-949-4971
Practice Address - Fax:616-974-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-19
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2081429Medicaid
235310Medicare Oscar/Certification