Provider Demographics
NPI:1417383845
Name:EASTSIDE MANOR
Entity type:Organization
Organization Name:EASTSIDE MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:MCEACHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-773-2569
Mailing Address - Street 1:1439 EAST ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-5424
Mailing Address - Country:US
Mailing Address - Phone:231-773-2569
Mailing Address - Fax:
Practice Address - Street 1:1439 EAST ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5424
Practice Address - Country:US
Practice Address - Phone:231-773-2569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility