Provider Demographics
NPI:1871741249
Name:CLARK RETIREMENT COMMUNITY INC.
Entity type:Organization
Organization Name:CLARK RETIREMENT COMMUNITY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT AND COLLECTIONS MANAG
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TUFTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-452-1568
Mailing Address - Street 1:1551 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-8203
Mailing Address - Country:US
Mailing Address - Phone:616-452-1568
Mailing Address - Fax:616-452-0428
Practice Address - Street 1:1551 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-8203
Practice Address - Country:US
Practice Address - Phone:616-452-1568
Practice Address - Fax:616-452-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health