Provider Demographics
NPI:1659811651
Name:KARSEN HOME
Entity Type:Organization
Organization Name:KARSEN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-745-2396
Mailing Address - Street 1:386 FOREST HILL AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2316
Mailing Address - Country:US
Mailing Address - Phone:616-745-2396
Mailing Address - Fax:
Practice Address - Street 1:386 FOREST HILL AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2316
Practice Address - Country:US
Practice Address - Phone:616-745-2396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI311ZA0620X253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI92053140Medicaid
MI92053140Medicaid