Healthcare Provider Details

I. General information

NPI: 1376354613
Provider Name (Legal Business Name): AIREONA IYON GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 BURTON ST SE
GRAND RAPIDS MI
49546-6121
US

IV. Provider business mailing address

4218 BURTON ST SE
GRAND RAPIDS MI
49546-6121
US

V. Phone/Fax

Practice location:
  • Phone: 616-301-8000
  • Fax:
Mailing address:
  • Phone: 313-618-8646
  • Fax:

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:
Title or Position:
Credential:
Phone: