Provider Demographics
NPI:1154754034
Name:NORTHCREST OPERATING CO.,INC.
Entity type:Organization
Organization Name:NORTHCREST OPERATING CO.,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:B
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-416-0600
Mailing Address - Street 1:5000 HAKES DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5574
Mailing Address - Country:US
Mailing Address - Phone:231-799-6882
Mailing Address - Fax:231-799-0250
Practice Address - Street 1:2650 RUDDIMAN DR
Practice Address - Street 2:
Practice Address - City:NORTH MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-3260
Practice Address - Country:US
Practice Address - Phone:231-744-2447
Practice Address - Fax:231-744-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAH610236856310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAH610236856OtherSTATE OF MICHIGAN DEPARTMENT OF HUMAN SERVICES