Healthcare Provider Details

I. General information

NPI: 1285584052
Provider Name (Legal Business Name): EVERBLOOM HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

144 BROWNELL ST SE
GRAND RAPIDS MI
49548-7702
US

IV. Provider business mailing address

PO BOX 1
OSHTEMO MI
49077-0001
US

V. Phone/Fax

Practice location:
  • Phone: 574-276-8612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE WILLIAMS
Title or Position: MEMBER
Credential:
Phone: 574-276-8612