Healthcare Provider Details

I. General information

NPI: 1790608057
Provider Name (Legal Business Name): A NORTH SIDE HOME CARE EXPERIENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 DORCHESTER AVE SW
GRAND RAPIDS MI
49503-4803
US

IV. Provider business mailing address

PO BOX 33
COMSTOCK PARK MI
49321
US

V. Phone/Fax

Practice location:
  • Phone: 616-334-1148
  • Fax:
Mailing address:
  • Phone: 616-334-1148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE TAYLOR
Title or Position: OWNER
Credential: TAYLOR
Phone: 616-334-1148