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General NPI Number Information
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NPI Number | 1023535754
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL EXPERIENCED ASSISTANT CARING FOR THE ELDERLY OF MIND
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 2410 INVERNESS ROAD
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City | GRAND RAPIDS
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State | MI
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Zip | 49546
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Country | US
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Telephone | 616-920-0369
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Fax |
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Provider Business Mailing Address
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Address Line | 2410 INVERNESS RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-5529
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF SALES & MARKETING
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Name | MR. ZACHARY ZWART
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Credential |
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Telephone | 320-444-6680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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