Healthcare Provider Details

I. General information

NPI: 1467953992
Provider Name (Legal Business Name): BETHLEHEM LUTHERAN CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 COMMERCE AVE SW
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

250 COMMERCE AVE SW
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-7509
  • Fax: 616-456-1759
Mailing address:
  • Phone: 616-456-7509
  • Fax: 616-456-1759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN MARIE SCHUELKE-DAVIDSON
Title or Position: DIRECTOR
Credential:
Phone: 616-456-7509