Healthcare Provider Details

I. General information

NPI: 1316644297
Provider Name (Legal Business Name): DAVID PAUL TAYLOR HOME CARE GIVER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 11/08/2025
Certification Date: 11/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10132 W LAUREL ST
LAKE CITY MI
49651-8810
US

IV. Provider business mailing address

414 5TH ST
CADILLAC MI
49601-1329
US

V. Phone/Fax

Practice location:
  • Phone: 616-227-1391
  • Fax: 907-313-1400
Mailing address:
  • Phone: 231-433-9086
  • Fax: 907-313-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1316644297
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number1316644297
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1316644297
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: