Healthcare Provider Details

I. General information

NPI: 1720386790
Provider Name (Legal Business Name): WELCOME HOMES RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CHERRY ST SE
GRAND RAPIDS MI
49503-4702
US

IV. Provider business mailing address

500 CHERRY ST SE
GRAND RAPIDS MI
49503-4702
US

V. Phone/Fax

Practice location:
  • Phone: 616-771-9741
  • Fax: 616-771-9771
Mailing address:
  • Phone: 616-771-9741
  • Fax: 616-771-9771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN SHEPARD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 616-771-9741