Healthcare Provider Details

I. General information

NPI: 1023477478
Provider Name (Legal Business Name): MARY FREE BED AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2016
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2944 FULLER AVE NE STE 301
GRAND RAPIDS MI
49505-3784
US

IV. Provider business mailing address

5440 CORPORATE DR STE 400
TROY MI
48098-2645
US

V. Phone/Fax

Practice location:
  • Phone: 855-602-2500
  • Fax: 855-632-4329
Mailing address:
  • Phone: 866-402-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KAREN L SLOAF
Title or Position: MANAGER OF REGULATORY AFFAIRS
Credential:
Phone: 855-602-2500