Healthcare Provider Details

I. General information

NPI: 1720901325
Provider Name (Legal Business Name): MARIJAH AMEIR LANCASTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 ORCHARD VISTA DR SE
GRAND RAPIDS MI
49546-7069
US

IV. Provider business mailing address

1233 SHERMAN ST SE
GRAND RAPIDS MI
49506-2611
US

V. Phone/Fax

Practice location:
  • Phone: 616-315-2326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: