Grace Haven Senior Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

GRACE HAVEN SENIOR LIVING LLC

Practice address

5191 N 41 1/2 Rd
Manton, MI 49663-9763

Phone

(231) 631-2689

Fax

(231) 824-7771

NPI assigned

Aug 12, 2025

Last updated

Aug 12, 2025By 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

Ms. Shelby L Mack

Title

Administrator

Phone

(231) 631-2689

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1754956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754956800000",
    "number": "1841176260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5191 N 41 1/2 RD",
            "city": "MANTON",
            "state": "MI",
            "postal_code": "496639763",
            "telephone_number": "231-631-2689",
            "fax_number": "231-824-7771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5191 N 41 1/2 RD",
            "city": "MANTON",
            "state": "MI",
            "postal_code": "496639763",
            "telephone_number": "231-631-2689",
            "fax_number": "231-824-7771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE HAVEN SENIOR LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-12",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "SHELBY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "231-631-2689",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brite White Dental PLLC
• Josie Clement
• Crystal Lake Clinic, PC
• Carrie Lynn Dextrom
• Katie Gardner
• Theophano Hartung, CPM, LM.
• Brent Alan Holmquist
• Stephen Hooper
• Karla Long
• Magnolia Care Afc Home LLC

• Assisted Living Facility in Manton, MI
• Providers in Manton, 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 Aug 12, 2025; 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.