NPIMap

Organization Active NPI

Resthaven

  • Skilled Nursing Facility
  • Holland, MI
National Provider Identifier
1942239223
Registry record updated Aug 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
03-405 Issued in MI
Legal business name
RESTHAVEN
Practice address
280 W 40TH St
Holland, MI 49423
Phone
(616) 796-3600
Fax
(616) 796-3609
NPI assigned
Jun 30, 2006
Last updated
Aug 14, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
RESTHAVENAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 14, 2018

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

Authorized official

Name
Deedre Vriesman
Title
Ceo/President
Phone
(616) 796-3503

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 03-405 MI Primary

Addresses

Primary practice location

280 W 40TH St
Holland, MI 49423

Mailing address

948 Washington Ave
Holland, MI 49423-5205
Phone (616) 796-3500

Other identifiers 2

IdentifierTypeStateIssuer
2587831MedicaidMI
09912OtherMIBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111116000388 MI Part A Provider - Skilled Nursing Facility 0749318962 Practice locations: Holland, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942239223. Details of each certification follow.

Skilled nursing facility certification: CCN 235378

Legal name
RESTHAVEN
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1980
Last certification
Jun 6, 2024
Beds
145
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Enrollment address
280 W 40TH St
Holland, MI 49423-4664
Nursing home name
RESTHAVEN CARE CENTER

Care Compare: Nursing home

Medicare Care Compare
Listed as
Resthaven Care CenterCCN 235378 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jan 1, 1980
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
145138.4 residents per day on average
Penalties (3 years)
1Fines totaling $0

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Resthaven3 organizations share this tax ID, including this one
Part of
Resthaven

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Robert T Carlson Individual Corporate DirectorDirector Jun 16, 2020
Ann Sterken Individual Corporate DirectorDirector Jun 24, 2019
Jason Bucher Individual Operational/Managerial Control Jul 10, 2023
Adp of the SNF Jul 29, 2025
David a Lutz Individual Corporate Director Jun 28, 2021
Kevin L Vanderklok Individual Corporate Director Jun 28, 2021
Deedre Schuckert Individual Corporate OfficerPresident/Ceo Apr 30, 2018
Operational/Managerial Control Apr 30, 2018
Adp of the SNF Apr 30, 2018
Old National Bank Organization, Evansville, IN Financial institution 5% Or Greater Mortgage Interest Jul 13, 2022 14%
Nina Bryhn Individual Operational/Managerial Control Dec 1, 2024
Adp of the SNF Jul 29, 2025
Terry Hofmeyer Individual Corporate Director May 20, 2024
Tom Riekse Individual Corporate Director May 20, 2024
Samuel Martin Individual Corporate DirectorDirector Apr 27, 2015
Philip Mulder Individual Corporate DirectorDirector Jun 24, 2019
Pam Vanputten Individual Corporate Director Jun 1, 2022
Barbara L Kleinheksel Individual Corporate DirectorDirector Jun 5, 2020
Nathan Baumann Individual Corporate Director Jun 1, 2019

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Atrio Home HealthGrand Rapids, MI, CCN 237208 Home health agency 5% Or Greater Indirect Ownership Interest (25%) Oct 11, 2024
Atrio Home Health LakeshoreHolland, MI, CCN 237411 Home health agency 5% Or Greater Indirect Ownership Interest (25%) Oct 11, 2024

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534204800000",
    "number": "1942239223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "948 WASHINGTON AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494235205",
            "telephone_number": "616-796-3500",
            "fax_number": "616-796-3508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 W 40TH ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "49423",
            "telephone_number": "616-796-3600",
            "fax_number": "616-796-3609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTHAVEN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RESTHAVEN",
        "enumeration_date": "2006-06-30",
        "last_updated": "2018-08-14",
        "status": "A",
        "authorized_official_last_name": "VRIESMAN",
        "authorized_official_first_name": "DEEDRE",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "616-796-3503"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "03-405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2587831",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "09912",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

Verify at the official NPI Registry.