MEDICARE: DEONNIE T DEARMON

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	310400000X	Assisted Living Facility	AF410418257	MI

General Provider Information

NPI Number	:	1922832492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEONNIE T DEARMON

Provider Business Mailing Address
First Line	:	1961 MILLBANK ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-2674
Country	:	US
Telephone Number	:	616-780-1527
Fax Number	:	616-719-3718

Provider Business Practice Location Address
First Line	:	1961 MILLBANK ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-2674
Country	:	US
Telephone Number	:	616-780-1527
Fax Number	:	616-719-3718

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

Provider Enumeration Date	:	08/28/2024
Last Update Date	:	08/28/2024

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Directions to “ DEONNIE T DEARMON ” Practice Location

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