Healthcare Provider Details

I. General information

NPI: 1972724771
Provider Name (Legal Business Name): NUTRITIONAL SERVICES FOR OLDER AMERICANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 W SHERMAN BLVD
MUSKEGON MI
49441-3543
US

IV. Provider business mailing address

1540 W SHERMAN BLVD
MUSKEGON MI
49441-3543
US

V. Phone/Fax

Practice location:
  • Phone: 231-755-0434
  • Fax: 231-755-7805
Mailing address:
  • Phone: 231-755-0434
  • Fax: 231-755-7805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: MS. SHARON TERHAAR
Title or Position: EXEC. DIRECTOR
Credential:
Phone: 231-755-0434