Provider Demographics
NPI:1396404240
Name:COMMUNITY
Entity Type:Organization
Organization Name:COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAEKESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:616-427-4570
Mailing Address - Street 1:1232 KALAMAZOO AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-1923
Mailing Address - Country:US
Mailing Address - Phone:616-427-4570
Mailing Address - Fax:
Practice Address - Street 1:225 CORINNE ST SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-1536
Practice Address - Country:US
Practice Address - Phone:616-427-4570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care