# NTL ADULT FOSTER CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316451065
- **Authorized official:** JOHNNIE R TYLER (OWNER)
- **Authorized official phone:** (616) 375-9786

## Contact information

- **Practice address:** 1056 BATES ST SE, GRAND RAPIDS, MI 49506-2681
- **Practice address phone:** (616) 647-5945
- **Mailing address:** 1056 BATES ST SE, GRAND RAPIDS, MI 49506-2681
- **Mailing address phone:** (616) 647-5945

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TA0700X | Adult Development & Aging Psychologist | — | NULL | Yes |
| 103TA0700X | Adult Development & Aging Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 11/16/2017
- **Last updated:** 11/16/2017