Healthcare Provider Details

I. General information

NPI: 1952485435
Provider Name (Legal Business Name): PULMONARY HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1049
US

IV. Provider business mailing address

5150 PLAINFIELD AVE NE
GRAND RAPIDS MI
49525-1049
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-4044
  • Fax: 616-364-4047
Mailing address:
  • Phone: 616-364-4044
  • Fax: 616-364-4047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. GORDON L PRESTON
Title or Position: PRESIDENT
Credential: CRT
Phone: 616-364-4044