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General NPI Number Information
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NPI Number | 1235594920
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Entity Type | Organization
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Legal Business Name | CHERRY HEALTH
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 12/22/2015
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Provider Practice Location Address
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Address Line | 101 SHELDON BLVD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4262
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Country | US
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Telephone | 616-776-2340
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Fax |
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Provider Business Mailing Address
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Address Line | 101 SHELDON BLVD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4262
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Country | US
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Telephone | 616-776-2340
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Fax |
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Authorized Official
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Title or Position | DENTAL HYGIENIST
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Name | MS. KIMBERLEY DAWN BARANOWSKI
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Credential | RDH
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Telephone | 616-776-2340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 2902009418
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License Number State | MI
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