Healthcare Provider Details

I. General information

NPI: 1679052997
Provider Name (Legal Business Name): SWAIN WALTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 EAST BELTLINE AVE SE SUITE 245
GRAND RAPIDS MI
49506
US

IV. Provider business mailing address

1550 EAST BELTLINE AVE SE SUITE 245
GRAND RAPIDS MI
49506
US

V. Phone/Fax

Practice location:
  • Phone: 616-975-1980
  • Fax: 616-942-1561
Mailing address:
  • Phone: 616-975-1980
  • Fax: 616-942-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT WALTERS LEONARD
Title or Position: MANAGER, BUSINESS OPERATIONS
Credential:
Phone: 616-975-1980