Provider Demographics
NPI:1184184939
Name:RIOS, LOUIS ANTHONY
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:ANTHONY
Last Name:RIOS
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 1:13327 JACKLYN DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-9534
Mailing Address - Country:US
Mailing Address - Phone:616-594-9319
Mailing Address - Fax:
Practice Address - Street 1:13327 JACKLYN DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-9534
Practice Address - Country:US
Practice Address - Phone:616-594-9319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0829OtherNON MEDICAL