Healthcare Provider Details

I. General information

NPI: 1407674831
Provider Name (Legal Business Name): COMMUNITY RIDSHARE AND ELDERLY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 EASTERN AVE SE APT 209
GRAND RAPIDS MI
49503-5578
US

IV. Provider business mailing address

623 EASTERN AVE SE APT 209
GRAND RAPIDS MI
49503-5578
US

V. Phone/Fax

Practice location:
  • Phone: 616-560-7003
  • Fax:
Mailing address:
  • Phone: 616-560-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: RACHEAL REID
Title or Position: OWNER AND OPERATOR
Credential:
Phone: 616-560-7003