Healthcare Provider Details

I. General information

NPI: 1932578465
Provider Name (Legal Business Name): HOME PRIMARY CARE MHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 09/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 S MICHIGAN RD
EATON RAPIDS MI
48827-9206
US

IV. Provider business mailing address

2285 S MICHIGAN RD
EATON RAPIDS MI
48827-9206
US

V. Phone/Fax

Practice location:
  • Phone: 517-386-1367
  • Fax: 877-489-3949
Mailing address:
  • Phone: 517-386-1367
  • Fax: 877-489-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN GRILLO
Title or Position: OWNER / PRESIDENT
Credential: MD
Phone: 231-250-1905