PINE RIDGE ADULT CARE HOME, LLC (NPI# 1730514290) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730514290 |
| Entity Type | Organization |
| Organization Name | PINE RIDGE ADULT CARE HOME, LLC |
| Other Organization Name | PINE RIDGE ASSISTED LIVING FACILITY |
| Practice Address |
15467 Port Sheldon St West Olive MI 49460-9715 |
| Practice Telephone | 6163991774 |
| Practice Fax Number | 6167380009 |
| Mailing Telephone | 6163991774 |
| Mailing Fax Number | 6167380009 |
| Enumeration Date | 2013-09-03 |
| Last Update Date | 2013-09-03 |
| Authorized Official Name | MRS. DEBRA ANN WESTERHOF I (LICENSEE) |
| Authorized Official Telephone | 6163991774 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | AL700079149 | MI | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Pine Ridge Assisted Living Facility | Doing Business As Name - Organization |
| Street Address |
15467 PORT SHELDON ST |
| City | WEST OLIVE |
| State | MI |
| Zip Code | 49460-9715 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902255714 | Matthew Tornga | Family Medicine | 15151 Stanton St Ste A, West Olive, MI 49460 | 2016-06-13 |
| 1407326648 | Bryan Castillo | Physical Therapist | 14715 Mayberry Dr, Port Sheldon, MI 49460-4946 | 2018-11-30 |
| 1699119412 | Ronald Dean Mulder | Obstetrics & Gynecology | 17236 Sandgate Pl, West Olive, MI 49460-8508 | 2013-04-23 |
| 1184610669 | Jack Richard Roossien Jr. | Family Medicine | 15151 Stanton St, Suite A, West Olive, MI 49460-8543 | 2005-09-21 |
| 1598223612 | Lindsey Ann Roossien | Family Medicine | 15151 Stanton St, West Olive, MI 49460-8543 | 2019-03-07 |
| 1609069244 | Eileen Marie Kishman | Physical Therapist | 15151 Stanton St, Suite B, West Olive, MI 49460-8543 | 2007-08-27 |
| 1497947618 | Physiotherapy Associates Inc | Clinic/Center | 15151 Stanton St, Ste B, West Olive, MI 49460-8543 | 2007-08-11 |
| 1740406982 | Jack R. Roossien Jr., M.d.p.c. | Family Medicine | 15151 Stanton St, Suite A, West Olive, MI 49460-8543 | 2007-04-17 |
| 1427086420 | Wendy L Bradley | Physical Therapist | 15151 Stanton St, Suite B, West Olive, MI 49460-8543 | 2006-06-29 |
| 1609802313 | Stanton Crossings Physical Therapy LLC | Physical Therapist | 15151 Stanton St, Suite B, West Olive, MI 49460-8543 | 2006-06-24 |
| Find all providers in zip 49460 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
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| 1215544739 | Baruch Sls, Inc. | Assisted Living Facility | 3100 Wyndham Dr, Flushing, MI 48433-2290 | 2020-09-29 |
| 1730796558 | Baruch Sls, Inc. | Assisted Living Facility | 130 Mary Ann St, Grayling, MI 49738-7037 | 2020-09-25 |
| 1649887472 | Baruch Sls, Inc. | Assisted Living Facility | 300 S Grand Ave, Leland, MI 49654-5052 | 2020-09-25 |
| 1013524834 | Baruch Sls, Inc. | Assisted Living Facility | 2801 Charlevoix Rd, Petoskey, MI 49770-9727 | 2020-09-25 |
| 1346857174 | Baruch Sls, Inc. | Assisted Living Facility | 1311 Southwestern Dr, Tecumseh, MI 49286-1233 | 2020-09-25 |
| 1427665439 | Baruch Sls, Inc. | Assisted Living Facility | 301 N Quick St, Blissfield, MI 49228-1051 | 2020-09-24 |
| 1295341956 | Comfort Home of Bloomfield Inc | Assisted Living Facility | 6372 Tutbury Ln, Troy, MI 48098-2151 | 2020-09-18 |
| 1306451679 | Traditions At Rivertown Park, LLC | Assisted Living Facility | 3555 Copper River Ave Sw, Wyoming, MI 49418-9791 | 2020-09-13 |
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| City | WEST OLIVE |
| Zip Code | 49460 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.