Provider Demographics
NPI:1023535754
Name:PROFESSIONAL EXPERIENCED ASSISTANT CARING FOR THE ELDERLY OF MIND
Entity Type:Organization
Organization Name:PROFESSIONAL EXPERIENCED ASSISTANT CARING FOR THE ELDERLY OF MIND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF SALES & MARKETING
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-444-6680
Mailing Address - Street 1:2410 INVERNESS RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2410 INVERNESS ROAD
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-920-0369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No347C00000XTransportation ServicesPrivate Vehicle