1629384052 NPI number — COMFORCARE SENIOR SERVICES - GRAND HAVEN

Table of content: (NPI 1629384052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629384052 NPI number — COMFORCARE SENIOR SERVICES - GRAND HAVEN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMFORCARE SENIOR SERVICES - GRAND HAVEN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629384052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11852 JUNIPER HILLS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND HAVEN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49417-9367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-842-2618
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 WASHINGTON AVE STE 380
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND HAVEN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49417-3318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-842-2618
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LYON
Authorized Official First Name:
EMMA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
616-402-9444

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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