Provider Demographics
NPI:1851732051
Name:TRILOGY HEALTHCARE OF CLINTON, LLC
Entity Type:Organization
Organization Name:TRILOGY HEALTHCARE OF CLINTON, LLC
Other - Org Name:THE WILLOWS AT EAST LANSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PLEVYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-213-1710
Mailing Address - Street 1:3500 COOLIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6376
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3500 COOLIDGE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6376
Practice Address - Country:US
Practice Address - Phone:502-412-5847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY FSC INVESTORS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility