Healthcare Provider Details

I. General information

NPI: 1992631485
Provider Name (Legal Business Name): JEFF&LISA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 PRESTWICK LN
PORTAGE MI
49024-4064
US

IV. Provider business mailing address

7205 PRESTWICK LN
PORTAGE MI
49024-4064
US

V. Phone/Fax

Practice location:
  • Phone: 269-400-6868
  • Fax:
Mailing address:
  • Phone: 269-400-6868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA VANDER PLOEG
Title or Position: CO-OWNER
Credential:
Phone: 269-400-6868