Healthcare Provider Details

I. General information

NPI: 1235438003
Provider Name (Legal Business Name): DAVID K CRAYCRAFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2011
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15880 STANTON ST
WEST OLIVE MI
49460-8972
US

IV. Provider business mailing address

15880 STANTON ST
WEST OLIVE MI
49460-8972
US

V. Phone/Fax

Practice location:
  • Phone: 616-795-3506
  • Fax: 616-850-0257
Mailing address:
  • Phone: 616-795-3506
  • Fax: 616-850-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: