Healthcare Provider Details

I. General information

NPI: 1669764296
Provider Name (Legal Business Name): HOME HEMO PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 BECKWITH VIEW AVE NE
GRAND RAPIDS MI
49505-5816
US

IV. Provider business mailing address

1406 BECKWITH VIEW AVE NE
GRAND RAPIDS MI
49505-5816
US

V. Phone/Fax

Practice location:
  • Phone: 616-337-2177
  • Fax:
Mailing address:
  • Phone: 616-337-2177
  • 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: GLORIA INGRAM
Title or Position: OWNER
Credential:
Phone: 616-337-2177