Healthcare Provider Details

I. General information

NPI: 1245779057
Provider Name (Legal Business Name): FIRST CARE LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 PALMER ST NE
GRAND RAPIDS MI
49505-4722
US

IV. Provider business mailing address

256 PALMER ST NE
GRAND RAPIDS MI
49505-4722
US

V. Phone/Fax

Practice location:
  • Phone: 616-419-0641
  • Fax: 616-288-9177
Mailing address:
  • Phone: 616-419-0641
  • Fax: 616-288-9177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberAF410370132
License Number StateMI

VIII. Authorized Official

Name: ASHLEY BUCY
Title or Position: OWNER
Credential:
Phone: 616-419-0641