Provider Demographics
NPI:1790113066
Name:RETIREMENT LIVING MANAGEMENT OF GREENVILLE
Entity Type:Organization
Organization Name:RETIREMENT LIVING MANAGEMENT OF GREENVILLE
Other - Org Name:GREEN ACRES GREENVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOEFLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-754-8850
Mailing Address - Street 1:1601 WINTER CREEK CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-1692
Mailing Address - Country:US
Mailing Address - Phone:616-754-8850
Mailing Address - Fax:616-754-8882
Practice Address - Street 1:1601 WINTER CREEK CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-1692
Practice Address - Country:US
Practice Address - Phone:616-754-8850
Practice Address - Fax:616-754-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM590244672311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility