Provider Demographics
NPI:1396975546
Name:PORTER HILLS PRESBYTERIAN VILLAGE, INC.
Entity type:Organization
Organization Name:PORTER HILLS PRESBYTERIAN VILLAGE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:616-893-3017
Mailing Address - Street 1:4450 CASCADE RD SE STE 200
Mailing Address - Street 2:
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:
Practice Address - Street 1:1029 E PARIS AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3603
Practice Address - Country:US
Practice Address - Phone:616-301-6209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility