CCG LAKESHORE INC (NPI# 1538167630) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538167630 |
| Entity Type | Organization |
| Organization Name | CCG LAKESHORE INC |
| Other Organization Name | RIVERSIDE NURSING AND REHABILITATION COMMUNITY |
| Practice Address |
415 Friant St Grand Haven MI 49417-2311 |
| Mailing Address |
5000 Hakes Dr Suite 600 Norton Shores MI 49441-5574 |
| Practice Telephone | 6168424120 |
| Practice Fax Number | 6168428742 |
| Mailing Telephone | 2317996870 |
| Mailing Fax Number | 2317990250 |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2020-01-06 |
| Authorized Official Name | JAMES FERKANY (SECRETARY) |
| Authorized Official Telephone | 6144546048 |
| Is Organization Subpart | Y |
| Parent Organization Name | CCG LAKESHORE INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 70-4090 | MI | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 60 2154623 | 05 | |
| MI | BCBS PROVIDER CODE | 09621 | 01 |
| Other Name | Type Code |
|---|---|
| Riverside Nursing and Rehabilitation Community | Doing Business As Name - Organization |
| Street Address |
415 FRIANT ST |
| City | GRAND HAVEN |
| State | MI |
| Zip Code | 49417-2311 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992277198 | Jennifer Jacobs | Speech-Language Pathologist | 415 Friant St, Grand Haven, MI 49417-2311 | 2018-12-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295393478 | Compassionate Christian Therapy, LLC | Social Worker | 16989 Robbins Rd, Grand Haven, MI 49417 | 2019-06-03 |
| 1275098501 | Christi Rene Fortenbacher | Massage Therapist | 318 S. Beacon Blvd, Grand Haven, MI 49417 | 2019-01-31 |
| 1518440650 | Jessica Hankins | Physical Therapy Assistant | 15773 Charles Ct, Grand Haven, MI 49417 | 2018-09-14 |
| 1558857466 | Christina Steege | Physical Therapist | 514 Friant St, Grand Haven, MI 49417 | 2018-07-03 |
| 1851822548 | Forefront Dermatology, S.c. | Dermatology | 1600 S Beacon Blvd, Suite 160, Grand Haven, MI 49417 | 2017-03-23 |
| 1982057907 | Jeremyn Duane Wiersma | Counselor | 1703 S. Despelder St., Grand Haven, MI 49417 | 2016-07-14 |
| 1760855225 | Lisa Costello | Dental Hygienist | 326 N. Ferry St, Grand Haven, MI 49417 | 2015-11-05 |
| 1508116088 | Great Lakes Chiropractic Health | Chiropractor | 15 S. Seventh St., Grand Haven, MI 49417 | 2012-09-12 |
| 1508120122 | Jonathan Stewart Rouwhorst | Family Medicine | 15161 Willowwood Ct, Grand Haven, MI 49417 | 2012-06-28 |
| 1104108836 | Employee Assistance Center Fulton | Psychologist | 321 Fulton, Grand Haven, MI 49417 | 2011-09-20 |
| Find all providers in zip 49417 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972092344 | Regency At Grand Haven, LLC | Skilled Nursing Facility | 17049 Comstock St, Grand Haven, MI 49417-7903 | 2018-05-01 |
| 1972697001 | Trinity Continuing Care Services | Skilled Nursing Facility | 900 S Beacon Blvd, Grand Haven, MI 49417-2146 | 2006-10-03 |
| 1770078263 | Grand Haven Opco, LLC | Skilled Nursing Facility | 900 S Beacon Blvd, Grand Haven, MI 49417 | 2018-06-27 |
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|---|---|---|---|---|
| 1538798731 | Windemere Park of Troy Operations LLC | Skilled Nursing Facility | 5990 N Adams Rd, Troy, MI 48098-2377 | 2020-04-08 |
| 1982235396 | Berg-lahser Snf, LLC | Skilled Nursing Facility | 21630 Hessel Ave # 1230, Detroit, MI 48219-1230 | 2020-02-04 |
| 1508497918 | Harmony Village Snf, LLC | Skilled Nursing Facility | 16588 Schaefer Hwy # 4249, Detroit, MI 48235-4249 | 2020-02-04 |
| 1336795244 | Ishpeming Nursing & Rehab Center, LLC | Skilled Nursing Facility | 435 Rd Pl, Ishpeming, MI 49849 | 2019-08-15 |
| 1669965299 | Wellbridge of Clarkston, LLC | Skilled Nursing Facility | 5655 Clarkston Road, Independence Township, MI 48348 | 2018-06-08 |
| 1104318112 | Wellbridge At Genesys Health Park, LLC | Skilled Nursing Facility | 3139 East Baldwin Road, Grand Blanc, MI 48439 | 2018-06-05 |
| 1427549955 | Mission Point of Detroit, LLC | Skilled Nursing Facility | 2102 Orleans, Detroit, MI 48207 | 2018-05-21 |
| 1912496324 | Regency At Independence Township, LLC | Skilled Nursing Facility | 6211 Stonewood Drive, Clarkston, MI 48346 | 2018-05-02 |
| 1093214173 | Sana Nasir Inc. | Skilled Nursing Facility | 13840 King Rd, Riverview, MI 48193 | 2018-02-05 |
| 1326565862 | Healthbridge LLC | Skilled Nursing Facility | 2060 Health Dr Sw, Wyoming, MI 49519-9687 | 2017-08-25 |
| Find all providers with the same taxonomy | ||||
| City | GRAND HAVEN |
| Zip Code | 49417 |
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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.