Healthcare Provider Details

I. General information

NPI: 1386595650
Provider Name (Legal Business Name): CALLIE L GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 IONIA AVE SW APT 224 APT.224
GRAND RAPIDS MI
49503-3118
US

IV. Provider business mailing address

4218 BURTON ST SE
GRAND RAPIDS MI
49546-6121
US

V. Phone/Fax

Practice location:
  • Phone: 616-401-0951
  • Fax:
Mailing address:
  • Phone: 616-401-0951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: