Healthcare Provider Details

I. General information

NPI: 1477850063
Provider Name (Legal Business Name): CATHOLIC CHARITIES WEST MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4304
US

IV. Provider business mailing address

40 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4304
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-1443
  • Fax: 616-732-6392
Mailing address:
  • Phone: 616-456-1443
  • Fax: 616-732-6392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBORAH J NYKAMP
Title or Position: PRESIDENT, CEO
Credential:
Phone: 616-243-0491