Provider Demographics
NPI:1295222578
Name:BARKER, GERALYN M
Entity Type:Individual
Prefix:
First Name:GERALYN
Middle Name:M
Last Name:BARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 TOWNSEND TRL NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9792
Mailing Address - Country:US
Mailing Address - Phone:616-443-0227
Mailing Address - Fax:
Practice Address - Street 1:1439 TOWNSEND TRL NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9792
Practice Address - Country:US
Practice Address - Phone:616-443-0227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS410391727311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAS410391727OtherLICENSE AFC