Provider Demographics
NPI:1982691564
Name:PILGRIM MANOR INC
Entity Type:Organization
Organization Name:PILGRIM MANOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSICK
Authorized Official - Suffix:
Authorized Official - Credentials:MPA, LNHA
Authorized Official - Phone:616-458-1133
Mailing Address - Street 1:2000 LEONARD ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-5837
Mailing Address - Country:US
Mailing Address - Phone:616-458-1133
Mailing Address - Fax:616-458-0743
Practice Address - Street 1:2000 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5837
Practice Address - Country:US
Practice Address - Phone:616-458-1133
Practice Address - Fax:616-458-0743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI414230314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2081367Medicaid
MI2081367Medicaid