Healthcare Provider Details

I. General information

NPI: 1134567662
Provider Name (Legal Business Name): VISITING NURSE SERVICES OF WESTERN MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CEDAR ST NE
GRAND RAPIDS MI
49503-1375
US

IV. Provider business mailing address

750 FULLER AVE NE
GRAND RAPIDS MI
49503-1918
US

V. Phone/Fax

Practice location:
  • Phone: 616-486-3900
  • Fax: 616-486-3980
Mailing address:
  • Phone: 616-486-2672
  • Fax: 616-459-3151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. KEVIN SMITH
Title or Position: VICE PRESIDENT FINANCE
Credential:
Phone: 616-486-2672