Healthcare Provider Details

I. General information

NPI: 1629425392
Provider Name (Legal Business Name): KACEY RAE RAMONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 MEADOW LN
GRAND HAVEN MI
49417-9238
US

IV. Provider business mailing address

1509 MEADOW LN
GRAND HAVEN MI
49417-9238
US

V. Phone/Fax

Practice location:
  • Phone: 231-730-1910
  • Fax:
Mailing address:
  • Phone: 231-730-1910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: