Active NPI
Holland Home
- Skilled Nursing Facility
- Grand Rapids, MI
National Provider Identifier
1972557460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 14196
- Legal business name
- HOLLAND HOME
- Practice address
- 1450 East Fulton
Grand Rapids, MI 49503-3854 - Phone
- (616) 643-2600
- Fax
- (616) 643-2623
- NPI assigned
- May 20, 2006
- Last updated
- Mar 10, 2016
- Organization subpart
- Yes
- Parent organization
- HOLLAND HOME
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. David Tiesenga
- Title
- Cfo
- Phone
- (616) 235-5035
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 14196 | MI | Primary |
Addresses
Primary practice location
1450 East Fulton
Grand Rapids, MI 49503-3854
Mailing address
1450 East Fulton
Grand Rapids, MI 49503-3854
Phone (616) 643-2600
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2081311 | Medicaid | MI | |
| 09887 | Other | BCBS OF MICHIGAN |
Other names 1
- Holland Home - Fulton Manor
National Provider Directory
National Provider Directory- Part of
- Holland Home
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Ownership & related parties
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.
-
- Skilled Nursing Facility
- Grand Rapids, MI
- NPI 1033287792
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148083200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1457568000000",
"number": "1972557460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1450 EAST FULTON",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495033854",
"telephone_number": "616-643-2600",
"fax_number": "616-643-2623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1450 EAST FULTON",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495033854",
"telephone_number": "616-643-2600",
"fax_number": "616-643-2623"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOLLAND HOME",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "HOLLAND HOME",
"enumeration_date": "2006-05-20",
"last_updated": "2016-03-10",
"status": "A",
"authorized_official_last_name": "TIESENGA",
"authorized_official_first_name": "DAVID",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "616-235-5035",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "MI",
"license": "14196",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2081311",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MICHIGAN",
"identifier": "09887",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Holland Home - Fulton Manor",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.