Provider Demographics
NPI:1700119302
Name:MARQUIS ENTERPRISES, LLC
Entity Type:Organization
Organization Name:MARQUIS ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:JOUPPI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:616-608-7555
Mailing Address - Street 1:3205 SOFT WATER LAKE DR NE
Mailing Address - Street 2:SUITE 104 B
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-2748
Mailing Address - Country:US
Mailing Address - Phone:616-608-7555
Mailing Address - Fax:616-608-7555
Practice Address - Street 1:3205 SOFT WATER LAKE DR NE
Practice Address - Street 2:SUITE 104 B
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-2748
Practice Address - Country:US
Practice Address - Phone:616-608-7555
Practice Address - Fax:616-608-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704089611101Y00000X, 163WA2000X, 171W00000X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty