Provider Demographics
NPI:1578739827
Name:ST ANN'S HOME
Entity Type:Organization
Organization Name:ST ANN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST REGISTERED
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARHAT-HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:616-735-1513
Mailing Address - Street 1:3683 MAPLEBROOK DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-2709
Mailing Address - Country:US
Mailing Address - Phone:616-735-1513
Mailing Address - Fax:
Practice Address - Street 1:2161 LEONARD NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504
Practice Address - Country:US
Practice Address - Phone:616-453-7715
Practice Address - Fax:616-735-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201006651314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility