Provider Demographics
NPI:1235479197
Name:MW MEMORY CARE, INC.
Entity Type:Organization
Organization Name:MW MEMORY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MINDI
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-863-9999
Mailing Address - Street 1:11629 NORTHLAND DR NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-7211
Mailing Address - Country:US
Mailing Address - Phone:616-863-9999
Mailing Address - Fax:616-863-9990
Practice Address - Street 1:11629 NORTHLAND DR NE
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7211
Practice Address - Country:US
Practice Address - Phone:616-863-9999
Practice Address - Fax:616-863-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care