Healthcare Provider Details

I. General information

NPI: 1063979607
Provider Name (Legal Business Name): BVN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 28TH ST SE STE 8
GRAND RAPIDS MI
49546-6935
US

IV. Provider business mailing address

6151 28TH ST SE STE 8
GRAND RAPIDS MI
49546-6935
US

V. Phone/Fax

Practice location:
  • Phone: 616-988-7878
  • Fax: 616-988-7070
Mailing address:
  • Phone: 616-988-7878
  • Fax: 616-988-7070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: VINCENT ERNEST ALTRUDA
Title or Position: EXECUTIVE DIRECTOR, OWNER
Credential:
Phone: 616-988-7878