Provider Demographics
NPI:1578284006
Name:JDS MIDLIFE TOOLS FOR LIVING PRACTICES LLC
Entity Type:Organization
Organization Name:JDS MIDLIFE TOOLS FOR LIVING PRACTICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:VEREYKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-217-9489
Mailing Address - Street 1:520 BUTTERNUT DR STE 8
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1587
Mailing Address - Country:US
Mailing Address - Phone:616-217-9489
Mailing Address - Fax:
Practice Address - Street 1:205 W 29TH ST STE 10
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-6973
Practice Address - Country:US
Practice Address - Phone:616-217-9489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty