Provider Demographics
NPI:1891116182
Name:MEADOWLARK RETIREMENT VILLAGE
Entity Type:Organization
Organization Name:MEADOWLARK RETIREMENT VILLAGE
Other - Org Name:PORTER HILLS RETIREMENT COMMUNITIES AND SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-949-4975
Mailing Address - Street 1:4450 CASCADE RD SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8330
Mailing Address - Country:US
Mailing Address - Phone:616-949-4975
Mailing Address - Fax:616-954-1795
Practice Address - Street 1:65 IDA RED AVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-1735
Practice Address - Country:US
Practice Address - Phone:616-887-8891
Practice Address - Fax:616-887-1795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORTER HILLS RETIREMENT COMMUNITIES AND SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL410085015251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health