Healthcare Provider Details

I. General information

NPI: 1033827365
Provider Name (Legal Business Name): TIDY HOME & HEALTH CLEANING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 BRIDGE ST NW APT 360
GRAND RAPIDS MI
49504-1706
US

IV. Provider business mailing address

1511 BRIDGE ST NW APT 360
GRAND RAPIDS MI
49504-1706
US

V. Phone/Fax

Practice location:
  • Phone: 616-915-0680
  • Fax:
Mailing address:
  • Phone: 616-915-0680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: PA'SHUN MINTER
Title or Position: OWNER
Credential:
Phone: 616-915-0680