Healthcare Provider Details

I. General information

NPI: 1558771337
Provider Name (Legal Business Name): ELICIA LAGRONE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 BENJAMIN AVE SE
GRAND RAPIDS MI
49506-3225
US

IV. Provider business mailing address

1112 BENJAMIN AVE SE
GRAND RAPIDS MI
49506-3225
US

V. Phone/Fax

Practice location:
  • Phone: 616-323-4219
  • Fax:
Mailing address:
  • Phone: 616-323-4219
  • 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:
Title or Position:
Credential:
Phone: