Provider Demographics
NPI:1669189445
Name:ABILITIIES OF WESTERN MICHIGAN
Entity type:Organization
Organization Name:ABILITIIES OF WESTERN MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:616-340-9026
Mailing Address - Street 1:2529 BRIDGEPORT LN SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-8431
Mailing Address - Country:US
Mailing Address - Phone:616-340-9026
Mailing Address - Fax:
Practice Address - Street 1:4488 BRETON RD SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-5270
Practice Address - Country:US
Practice Address - Phone:616-340-9026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No174200000XOther Service ProvidersMeals
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center