Provider Demographics
NPI:1508262676
Name:RETIREMENT LIVING MANAGEMENT OF STANDALE L.L.C
Entity Type:Organization
Organization Name:RETIREMENT LIVING MANAGEMENT OF STANDALE L.L.C
Other - Org Name:GREEN ACRES OF STANDALE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-431-3021
Mailing Address - Street 1:11276 1ST AVENUE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534
Mailing Address - Country:US
Mailing Address - Phone:616-431-3021
Mailing Address - Fax:616-431-3022
Practice Address - Street 1:1845 BIRMINGHAM
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-8664
Practice Address - Country:US
Practice Address - Phone:616-431-3021
Practice Address - Fax:616-431-3022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL700355094310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility