Healthcare Provider Details

I. General information

NPI: 1801526728
Provider Name (Legal Business Name): MICHELE S ALEXANDER CPRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELE S ALEXANDER RECOVERY COACH

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 BALL AVE NE
GRAND RAPIDS MI
49505-5904
US

IV. Provider business mailing address

10059 S SHERIDAN RD
FENWICK MI
48834-9703
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-6571
  • Fax: 616-774-2044
Mailing address:
  • Phone: 989-763-9119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: