Provider Demographics
NPI:1891150330
Name:CHERRY SUITE ASSISTED LIVING
Entity Type:Organization
Organization Name:CHERRY SUITE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ULRICH
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:231-534-5055
Mailing Address - Street 1:10774 S US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49690-9419
Mailing Address - Country:US
Mailing Address - Phone:231-534-5055
Mailing Address - Fax:
Practice Address - Street 1:10774 S US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-9419
Practice Address - Country:US
Practice Address - Phone:231-534-5055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM050320275310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility