Provider Demographics
NPI:1386223477
Name:MEADOWS BY THE LAKE INC
Entity Type:Organization
Organization Name:MEADOWS BY THE LAKE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-894-8189
Mailing Address - Street 1:904 OAK DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-8230
Mailing Address - Country:US
Mailing Address - Phone:616-894-8198
Mailing Address - Fax:
Practice Address - Street 1:904 OAK DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-8230
Practice Address - Country:US
Practice Address - Phone:616-894-8198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility