Provider Demographics
NPI:1770918773
Name:HOME REPAIR SERVICES OF KENT COUNTY, INC.
Entity type:Organization
Organization Name:HOME REPAIR SERVICES OF KENT COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:616-241-2601
Mailing Address - Street 1:1100 DIVISION AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-1024
Mailing Address - Country:US
Mailing Address - Phone:616-241-2601
Mailing Address - Fax:616-241-5151
Practice Address - Street 1:1100 DIVISION AVE S
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-1024
Practice Address - Country:US
Practice Address - Phone:616-241-2601
Practice Address - Fax:616-241-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI171WH0202X171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty