Healthcare Provider Details

I. General information

NPI: 1316286131
Provider Name (Legal Business Name): TOBACCO FREE PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 JEFFERSON AVE SE SUITE 130
GRAND RAPIDS MI
49503-4306
US

IV. Provider business mailing address

150 JEFFERSON AVE SE SUITE 130
GRAND RAPIDS MI
49503-4306
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-1411
  • Fax:
Mailing address:
  • Phone: 616-685-1411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA VAN HEEST
Title or Position: EDUCATION AND PROGRAM COORDINATOR
Credential:
Phone: 616-685-1411