Provider Demographics
NPI:1497530539
Name:MITTEN HOME INFUSION
Entity Type:Organization
Organization Name:MITTEN HOME INFUSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, NURSING OPERATI
Authorized Official - Prefix:
Authorized Official - First Name:CHANTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:616-308-2473
Mailing Address - Street 1:5695 GRAND RIVER DR NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8662
Mailing Address - Country:US
Mailing Address - Phone:616-308-2473
Mailing Address - Fax:
Practice Address - Street 1:5695 GRAND RIVER DR NE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8662
Practice Address - Country:US
Practice Address - Phone:616-308-2473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing CareGroup - Multi-Specialty