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NPI Code Detail

MEDICARE: GRACE KETCHMARK

MEDICARE: GRACE KETCHMARK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT26511889MI

General Provider Information

NPI Number : 1154277267
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE KETCHMARK
Provider Business Mailing Address
First Line : 16925 ABILITY WAY
Second Line :
City : GRAND HAVEN
State : MI
Zip : 49417-9325
Country : US
Telephone Number : 616-935-7606
Fax Number :
Provider Business Practice Location Address
First Line : 16925 ABILITY WAY
Second Line :
City : GRAND HAVEN
State : MI
Zip : 49417-9325
Country : US
Telephone Number : 616-935-7606
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2026
Last Update Date : 03/10/2026

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Directions to “ GRACE KETCHMARK ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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