Healthcare Provider Details

I. General information

NPI: 1285295378
Provider Name (Legal Business Name): AMBERLYN ROSE ERLENBECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 08/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 THREE MILE RD NW SUITE 100
GRAND RAPIDS MI
49544
US

IV. Provider business mailing address

721 THREE MILE RD NW SUITE 100
GRAND RAPIDS MI
49544
US

V. Phone/Fax

Practice location:
  • Phone: 616-608-8933
  • Fax: 616-608-8934
Mailing address:
  • Phone: 616-608-8933
  • Fax: 616-608-8934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: