Healthcare Provider Details

I. General information

NPI: 1649810441
Provider Name (Legal Business Name): HANNAH ELIZABETH CROUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BALL AVE NE
GRAND RAPIDS MI
49505-5904
US

IV. Provider business mailing address

3145 20TH ST
HOPKINS MI
49328-9732
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-6571
  • Fax: 616-774-2044
Mailing address:
  • Phone: 616-821-6192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: