Healthcare Provider Details

I. General information

NPI: 1629893276
Provider Name (Legal Business Name): MECAS ANGELS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 28TH ST SE STE 101E
GRAND RAPIDS MI
49508-1399
US

IV. Provider business mailing address

950 28TH ST SE STE 101E
GRAND RAPIDS MI
49508-1399
US

V. Phone/Fax

Practice location:
  • Phone: 616-422-6941
  • Fax:
Mailing address:
  • Phone: 616-422-6941
  • 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: TIFFANY FAWN CONLEY
Title or Position: CEO/FOUNDER
Credential: RN
Phone: 616-422-6941