Crestwood Village Assisted Living

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

AH370325563 Issued in MI

Legal business name

CRESTWOOD VILLAGE ASSISTED LIVING

Practice address

2378 South Lincoln Rd
Mt. Pleasant, MI 48858

Phone

(989) 772-2183

Fax

(989) 772-2296

NPI assigned

Aug 27, 2013

Organization subpart

Yes

Parent organization

LEISURE LIVING MANAGEMENTAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Samantha Thelen

Title

Director of Operations

Phone

(517) 881-6051

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1377561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425859200000",
    "number": "1114351152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3196 KRAFT AVE SE",
            "address_2": "SUITE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495122078",
            "telephone_number": "616-464-1564",
            "fax_number": "616-464-2470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2378 SOUTH LINCOLN RD",
            "city": "MT. PLEASANT",
            "state": "MI",
            "postal_code": "48858",
            "telephone_number": "989-772-2183",
            "fax_number": "989-772-2296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRESTWOOD VILLAGE ASSISTED LIVING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LEISURE LIVING MANAGEMENT",
        "enumeration_date": "2013-08-27",
        "last_updated": "2015-03-09",
        "status": "A",
        "authorized_official_last_name": "THELEN",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "517-881-6051",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MI",
            "license": "AH370325563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in Mt. Pleasant, MI
• Providers in Mt. Pleasant, MI by specialty
• Exclusive Provider Organization in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.