Pine Ridge Adult Care Home, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL700079149 Issued in MI

Legal business name

PINE RIDGE ADULT CARE HOME, LLC

Doing business as

Pine Ridge Assisted Living Facility

Practice address

15467 Port Sheldon St
West Olive, MI 49460-9715

Phone

(616) 399-1774

Fax

(616) 738-0009

NPI assigned

Sep 3, 2013

Last updated

Sep 3, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Debra Ann Westerhof I

Title

Licensee

Phone

(616) 399-1774

Specialties & licenses 1

Addresses

Other names 1

• Pine Ridge Assisted Living Facility Doing business as

Locations

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

{
    "created_epoch": "1378166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378166400000",
    "number": "1730514290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15467 PORT SHELDON ST",
            "city": "WEST OLIVE",
            "state": "MI",
            "postal_code": "494609715",
            "telephone_number": "616-399-1774",
            "fax_number": "616-738-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15467 PORT SHELDON ST",
            "city": "WEST OLIVE",
            "state": "MI",
            "postal_code": "494609715",
            "telephone_number": "616-399-1774",
            "fax_number": "616-738-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE RIDGE ADULT CARE HOME, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-03",
        "last_updated": "2013-09-03",
        "status": "A",
        "authorized_official_last_name": "WESTERHOF",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "LICENSEE",
        "authorized_official_telephone_number": "616-399-1774",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_name_suffix": "I"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MI",
            "license": "AL700079149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Ridge Assisted Living Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in West Olive, MI
• Providers in West Olive, 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 Sep 3, 2013; 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.