Provider Demographics
NPI:1841176260
Name:GRACE HAVEN SENIOR LIVING LLC
Entity type:Organization
Organization Name:GRACE HAVEN SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-631-2689
Mailing Address - Street 1:5191 N 41 1/2 RD
Mailing Address - Street 2:
Mailing Address - City:MANTON
Mailing Address - State:MI
Mailing Address - Zip Code:49663-9763
Mailing Address - Country:US
Mailing Address - Phone:231-631-2689
Mailing Address - Fax:231-824-7771
Practice Address - Street 1:5191 N 41 1/2 RD
Practice Address - Street 2:
Practice Address - City:MANTON
Practice Address - State:MI
Practice Address - Zip Code:49663-9763
Practice Address - Country:US
Practice Address - Phone:231-631-2689
Practice Address - Fax:231-824-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility