Provider Demographics
NPI:1639881246
Name:ALDEN, RICH L (MS COMS)
Entity Type:Individual
Prefix:
First Name:RICH
Middle Name:L
Last Name:ALDEN
Suffix:
Gender:M
Credentials:MS COMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49094-1022
Mailing Address - Country:US
Mailing Address - Phone:508-510-2495
Mailing Address - Fax:
Practice Address - Street 1:404 DIVISION ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:MI
Practice Address - Zip Code:49094-1022
Practice Address - Country:US
Practice Address - Phone:508-510-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
6704171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6704OtherACVREP CERTIFICATION