Provider Demographics
NPI:1093045858
Name:WEST MICHIGAN MNT,LLC
Entity Type:Organization
Organization Name:WEST MICHIGAN MNT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOULE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:231-215-5125
Mailing Address - Street 1:4933 STANWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5456
Mailing Address - Country:US
Mailing Address - Phone:231-215-5125
Mailing Address - Fax:231-760-4731
Practice Address - Street 1:433 SEMINOLE RD STE 204
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-3743
Practice Address - Country:US
Practice Address - Phone:231-215-5125
Practice Address - Fax:231-760-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty