Provider Demographics
NPI:1891792735
Name:HEATHER HILLS LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:HEATHER HILLS LIMITED PARTNERSHIP
Other - Org Name:HEATHER HILLS CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DOCKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:616-949-7310
Mailing Address - Street 1:1157 MEDICAL PARK DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3699
Mailing Address - Country:US
Mailing Address - Phone:616-949-7310
Mailing Address - Fax:616-956-0973
Practice Address - Street 1:1157 MEDICAL PARK DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3699
Practice Address - Country:US
Practice Address - Phone:616-949-7310
Practice Address - Fax:616-956-0973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI414370313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility