Crestview SNF, LLC

Key facts

NPI

1073002606

Entity type

Organization (NPI type 2)

Primary specialty

Skilled Nursing Facility 314000000X

Legal business name

CRESTVIEW SNF, LLC

Practice address

625 36TH St SW
Wyoming, MI 49509

Phone

(616) 531-0200

NPI assigned

May 9, 2018

Organization subpart

No

Authorized official

Name

Yair Zuckerman

Title

Manager

Phone

(773) 517-4777

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Noelle K Franklyn, MD Family Medicine Physician · North Muskegon, MI · NPI 1235145244
  NPD (past)
• Gregg Thomas Malicke, D.O. Emergency Medicine Physician · Big Rapids, MI · NPI 1417211087
  NPD (past)
• Miriam Yvonne Veldt, MD Family Medicine Physician · Portage, MI · NPI 1295965499
  NPD (past)

National Provider Directory

Specialties & licenses

Addresses

Other names

• Illuminate HC Wyoming Doing business as
• SKLD Wyoming Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 17, 2018.

{
    "created_epoch": "1525824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534464000000",
    "number": "1073002606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 DAVIS ST STE 200",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602014419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 36TH ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "49509",
            "telephone_number": "616-531-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTVIEW SNF, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-09",
        "last_updated": "2018-08-17",
        "status": "A",
        "authorized_official_last_name": "ZUCKERMAN",
        "authorized_official_first_name": "YAIR",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "773-517-4777"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Illuminate HC Wyoming",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SKLD Wyoming",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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