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General NPI Number Information
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NPI Number | 1346517695
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Entity Type | Organization
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Legal Business Name | HARBOR HOUSE MINISTRIES, INC
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 919 44TH AVE
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City | JENISON
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State | MI
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Zip | 49428-9193
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Country | US
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Telephone | 616-797-9920
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Fax | 616-797-9921
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Provider Business Mailing Address
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Address Line | 919 44TH AVE
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City | JENISON
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State | MI
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Zip | 49428-9193
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Country | US
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Telephone | 616-797-9920
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Fax | 616-797-9921
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Authorized Official
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Title or Position | SECRETARY, BOARD OF DIRECTORS
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Name | MRS. RENEE MICHELLE VELTEMA
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Credential |
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Telephone | 616-797-9920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AM700257038
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License Number State | MI
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