MEDICARE: PARACLETE FAMILY SERVICES LLC

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
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1205301199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARACLETE FAMILY SERVICES LLC

Provider Business Mailing Address
First Line	:	2944 FULLER AVE NE STE 201
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-3784
Country	:	US
Telephone Number	:	616-988-5155
Fax Number	:	616-988-0077

Provider Business Practice Location Address
First Line	:	2944 FULLER AVE NE STE 201
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-3784
Country	:	US
Telephone Number	:	616-988-5155
Fax Number	:	616-988-0077

Authorized Official
Title or Position	:	OWNER
Name	:	BARB BEILFUSS
Credential	:
Telephone Number	:	616-988-5155

Provider Enumeration Date	:	10/08/2018
Last Update Date	:	10/08/2018

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