Healthcare Provider Details

I. General information

NPI: 1154694750
Provider Name (Legal Business Name): PLACES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E LINCOLN AVE
IONIA MI
48846-1393
US

IV. Provider business mailing address

910 E LINCOLN AVE
IONIA MI
48846-1393
US

V. Phone/Fax

Practice location:
  • Phone: 616-527-2370
  • Fax: 616-527-3824
Mailing address:
  • Phone: 616-527-2370
  • Fax: 616-527-3824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704176032
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704172952
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101008296
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501013000
License Number StateMI

VIII. Authorized Official

Name: ANNE BUECHE
Title or Position: ADMINISTRATOR
Credential:
Phone: 616-302-0808