River Ridge Retirement Village

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL800095787 Issued in MI

Legal business name

RIVER RIDGE RETIREMENT VILLAGE

Practice address

706 Kentucky Ave
South Haven, MI 49090-9607

Phone

(269) 639-7310

NPI assigned

Nov 17, 2009

Organization subpart

No

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

Authorized official

Name

Kathy Pawlicki

Title

Administrator

Phone

(269) 639-7310

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1258416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258416000000",
    "number": "1396072088",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 KENTUCKY AVE",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490909607",
            "telephone_number": "269-639-7310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER RIDGE RETIREMENT VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-17",
        "last_updated": "2009-11-17",
        "status": "A",
        "authorized_official_last_name": "PAWLICKI",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "269-639-7310"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MI",
            "license": "AL800095787",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "23D1102188",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tracy Ralicki, OTR
• Randall Scott Davis
• Elizabeth A Rasmussen, MSW
• Renal Care Group Southwest Michigan, LLC
• Ripple Effects Autism Learning Center, LLC
• River Ridge Retirement Village L L C
• Frances Suerte Roden
• Susan Marie Rose-Tapper, RN
• Meghan Rzeszutko, FNP
• Donald Robert Salmon, PA C

• Assisted Living Facility in South Haven, MI
• Providers in South Haven, MI by specialty
• Assisted Living Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; 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.