MEDICARE: MRS. LA QUINN MENIER CCM

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1689171365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LA QUINN MENIER CCM

Provider Business Mailing Address
First Line	:	2215 OAK INDUSTRIAL DR NE STE 113
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-6037
Country	:	US
Telephone Number	:	616-920-0539
Fax Number	:

Provider Business Practice Location Address
First Line	:	2215 OAK INDUSTRIAL DR NE STE 113
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-6037
Country	:	US
Telephone Number	:	616-920-0539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	12/22/2021

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