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General NPI Number Information
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NPI Number | 1467953992
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Entity Type | Organization
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Legal Business Name | BETHLEHEM LUTHERAN CHURCH
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 02/21/2018
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Provider Practice Location Address
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Address Line | 250 COMMERCE AVE SW
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City | GRAND RAPIDS
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State | MI
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Zip | 49503
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Country | US
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Telephone | 616-456-7509
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Fax | 616-456-1759
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Provider Business Mailing Address
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Address Line | 250 COMMERCE AVE SW
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City | GRAND RAPIDS
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State | MI
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Zip | 49503
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Country | US
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Telephone | 616-456-7509
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Fax | 616-456-1759
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Authorized Official
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Title or Position | DIRECTOR
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Name | SUSAN MARIE SCHUELKE-DAVIDSON
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Credential |
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Telephone | 616-456-7509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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