Healthcare Provider Details

I. General information

NPI: 1083730972
Provider Name (Legal Business Name): SPARROW COMMUNITY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3192 COMMERCE LN SUITE C4
IONIA MI
48846-9816
US

IV. Provider business mailing address

3301 E MICHIGAN AVE STE A
LANSING MI
48912-4641
US

V. Phone/Fax

Practice location:
  • Phone: 616-522-0515
  • Fax: 616-522-0517
Mailing address:
  • Phone: 517-364-2115
  • Fax: 517-364-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number383243561
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number383243561
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number383243561
License Number StateMI

VIII. Authorized Official

Name: MICHAEL TOBIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 517-364-8044