Healthcare Provider Details

I. General information

NPI: 1205462850
Provider Name (Legal Business Name): REEMAN CHRISTIAN REFORMED CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 S FITZGERALD AVE
FREMONT MI
49412-9120
US

IV. Provider business mailing address

6121 S FITZGERALD AVE
FREMONT MI
49412-9120
US

V. Phone/Fax

Practice location:
  • Phone: 231-638-8786
  • Fax:
Mailing address:
  • Phone: 231-638-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMMY COWLEY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 231-638-8786