Basic Information
| Provider Information | |||||||||
| NPI: | 1750624888 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOWELL NURSING, LLC | ||||||||
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| OtherOrganizationName: | WHITE PINE REHABILITATION & HEALTHCARE OF HOWELL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 IONIA AVE SW STE 506 | ||||||||
| Address2: | WHITE PINE MANAGEMENT, LLC C/O BIG BAY VENTURES, LLC | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019911388 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3003 W GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | HOWELL | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488438539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5175464210 | ||||||||
| FaxNumber: | 5175467661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2013 | ||||||||
| LastUpdateDate: | 03/27/2013 | ||||||||
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| AuthorizedOfficialLastName: | BOLT | ||||||||
| AuthorizedOfficialFirstName: | BRETTON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO/MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3019911388 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PVFS NURSING PARENT, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.