Healthcare Provider Details

I. General information

NPI: 1275975179
Provider Name (Legal Business Name): LITTLE RED HOUSE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 E EXCHANGE ST
SPRING LAKE MI
49456-2022
US

IV. Provider business mailing address

311 E EXCHANGE ST
SPRING LAKE MI
49456-2022
US

V. Phone/Fax

Practice location:
  • Phone: 616-846-5720
  • Fax: 616-935-0688
Mailing address:
  • Phone: 616-846-5720
  • Fax: 616-935-0688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JODY B HERRELKO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 616-846-5720