Provider Demographics
NPI:1174577761
Name:HOLLAND HOME
Entity type:Organization
Organization Name:HOLLAND HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-235-5015
Mailing Address - Street 1:2589 44TH STREET
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-3877
Mailing Address - Country:US
Mailing Address - Phone:616-235-2500
Mailing Address - Fax:616-235-2514
Practice Address - Street 1:2589 44TH STREET
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49512-3877
Practice Address - Country:US
Practice Address - Phone:616-235-2500
Practice Address - Fax:616-235-2514
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLLAND HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-19
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14117314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
09658OtherBCBS OF MICHIGAN
MI2702700Medicaid
09658OtherBCBS OF MICHIGAN