Provider Demographics
NPI:1700314564
Name:COVENANT ENABLING RESIDENCES OF MICHIGAN
Entity Type:Organization
Organization Name:COVENANT ENABLING RESIDENCES OF MICHIGAN
Other - Org Name:COVENANT ABILITY NETWORK OF MICHIGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-340-5942
Mailing Address - Street 1:862 FOREST PARK RD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-4631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 THORNRIDGE CT NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-5887
Practice Address - Country:US
Practice Address - Phone:616-272-4984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-24
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home