Healthcare Provider Details

I. General information

NPI: 1114385531
Provider Name (Legal Business Name): AHR PROFESSIONALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2207 PORTER ST SW CONDO 108
WYOMING MI
49519-2276
US

IV. Provider business mailing address

2207 PORTER ST SW CONDO 108
WYOMING MI
49519-2276
US

V. Phone/Fax

Practice location:
  • Phone: 616-261-4170
  • Fax: 616-929-4482
Mailing address:
  • Phone: 616-261-4170
  • Fax: 616-929-4482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number43202
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number43202
License Number StateCA

VIII. Authorized Official

Name: MR. TIMOTHY BOS
Title or Position: PHARMACIST
Credential: RPH
Phone: 616-261-4170