Healthcare Provider Details

I. General information

NPI: 1497645329
Provider Name (Legal Business Name): RONALD L MEKKES JR. COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 LEONARD ST NW
GRAND RAPIDS MI
49504-3818
US

IV. Provider business mailing address

510 PARIS AVE SE
GRAND RAPIDS MI
49503-5404
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-1133
  • Fax:
Mailing address:
  • Phone: 616-443-7094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: