Provider Demographics
NPI:1558949206
Name:DRAMMEH, EBRIMA
Entity Type:Individual
Prefix:
First Name:EBRIMA
Middle Name:
Last Name:DRAMMEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 GIDDINGS AVE SE APT 1
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-2222
Mailing Address - Country:US
Mailing Address - Phone:269-447-5460
Mailing Address - Fax:
Practice Address - Street 1:1531 GIDDINGS AVE SE APT 1
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-2222
Practice Address - Country:US
Practice Address - Phone:269-447-5460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF410402484311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAF410402484OtherAFC LICENSE