Provider Demographics
NPI:1780633354
Name:THURSTON WOODS VILLAGE, INC.
Entity Type:Organization
Organization Name:THURSTON WOODS VILLAGE, INC.
Other - Org Name:FROH COMMUNITY HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-651-7841
Mailing Address - Street 1:307 N FRANKS AVE
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-1277
Mailing Address - Country:US
Mailing Address - Phone:269-651-7841
Mailing Address - Fax:269-651-2050
Practice Address - Street 1:307 N FRANKS AVE
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1277
Practice Address - Country:US
Practice Address - Phone:269-651-7841
Practice Address - Fax:269-651-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI754060314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1658966Medicaid
MI1658966Medicaid
MI235345Medicare ID - Type UnspecifiedPROVIDER ID