Healthcare Provider Details

I. General information

NPI: 1114861598
Provider Name (Legal Business Name): A.W.E.MAZING CTR INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 ROSEWATER DR NE UNIT 219
GRAND RAPIDS MI
49525-2981
US

IV. Provider business mailing address

2560 ROSEWATER DR NE UNIT 219
GRAND RAPIDS MI
49525-2981
US

V. Phone/Fax

Practice location:
  • Phone: 616-856-8770
  • Fax:
Mailing address:
  • Phone: 616-856-8770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TONYA L HARRIS
Title or Position: OWNER
Credential:
Phone: 616-856-8770