Provider Demographics
NPI:1275910150
Name:LOVE INC OF THE TRI-CITIES
Entity Type:Organization
Organization Name:LOVE INC OF THE TRI-CITIES
Other - Org Name:LOVE INC FREE HEALTH AND DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTERY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:616-846-2701
Mailing Address - Street 1:326 N FERRY ST
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1183
Mailing Address - Country:US
Mailing Address - Phone:616-846-2701
Mailing Address - Fax:
Practice Address - Street 1:326 N FERRY ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1183
Practice Address - Country:US
Practice Address - Phone:616-846-2701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental