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General NPI Number Information
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NPI Number | 1922832492
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Entity Type | Individual
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Provider Name | DEONNIE T DEARMON
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Gender | Female
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Dates
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Enumeration Date | 08/28/2024
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 1961 MILLBANK ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-2674
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Country | US
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Telephone | 616-780-1527
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Fax | 616-719-3718
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Provider Business Mailing Address
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Address Line | 1961 MILLBANK ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-2674
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Country | US
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Telephone | 616-780-1527
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Fax | 616-719-3718
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AF410418257
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License Number State | MI
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