Healthcare Provider Details

I. General information

NPI: 1700314564
Provider Name (Legal Business Name): COVENANT ENABLING RESIDENCES OF MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 01/29/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 THORNRIDGE CT NW
GRAND RAPIDS MI
49504-5887
US

IV. Provider business mailing address

862 FOREST PARK RD
NORTON SHORES MI
49441-4631
US

V. Phone/Fax

Practice location:
  • Phone: 616-272-4984
  • 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: MR. RICK J LARMAN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 616-340-5942