Provider Demographics
NPI:1528778461
Name:STANFORD LODGE
Entity type:Organization
Organization Name:STANFORD LODGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VASHU
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-718-9040
Mailing Address - Street 1:409 NAOMI ST
Mailing Address - Street 2:
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080-1222
Mailing Address - Country:US
Mailing Address - Phone:269-685-5821
Mailing Address - Fax:269-685-5796
Practice Address - Street 1:409 NAOMI ST
Practice Address - Street 2:
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080-1222
Practice Address - Country:US
Practice Address - Phone:269-685-5821
Practice Address - Fax:269-685-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility