Provider Demographics
NPI:1740433846
Name:DISABILITY ADVOCATES OF KENT COUNTY
Entity type:Organization
Organization Name:DISABILITY ADVOCATES OF KENT COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BULKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:616-949-1100
Mailing Address - Street 1:3600 CAMELOT DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8103
Mailing Address - Country:US
Mailing Address - Phone:616-949-1100
Mailing Address - Fax:616-949-7865
Practice Address - Street 1:3600 CAMELOT DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8103
Practice Address - Country:US
Practice Address - Phone:616-949-1100
Practice Address - Fax:616-949-7865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care