Healthcare Provider Details

I. General information

NPI: 1770057622
Provider Name (Legal Business Name): ENRICHMENT MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 ALGER ST SE
GRAND RAPIDS MI
49507-3593
US

IV. Provider business mailing address

734 ALGER ST SE
GRAND RAPIDS MI
49507-3593
US

V. Phone/Fax

Practice location:
  • Phone: 616-247-1800
  • Fax: 616-247-0460
Mailing address:
  • Phone: 616-247-1800
  • Fax: 616-247-0460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. BRUCE ALAN HELDER
Title or Position: PRESIDENT
Credential:
Phone: 616-247-1800