Provider Demographics
NPI:1831330935
Name:WISHING WELL, INC.
Entity type:Organization
Organization Name:WISHING WELL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICE PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:V
Authorized Official - Last Name:HEERINGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-363-9113
Mailing Address - Street 1:1721 RODNEY CR. N.E.
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505
Mailing Address - Country:US
Mailing Address - Phone:616-363-9113
Mailing Address - Fax:
Practice Address - Street 1:1721 RODNEY CR. N.E.
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505
Practice Address - Country:US
Practice Address - Phone:616-363-9113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WISHING WELL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty