# AEGIN PLACE OF WEST MICHIGAN

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Aegin Place of West Michigan LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366657744
- **Authorized official:** MR. LANCE GRAGG (OWNER/CEO)
- **Authorized official phone:** (231) 375-5356

## Contact information

- **Practice address:** 333 W. WESTERN AVE STE 209, MUSKEGON, MI 49440
- **Practice address phone:** (231) 375-5356
- **Practice address fax:** (231) 756-7211
- **Mailing address:** 333 W. WESTERN AVE STE 209, MUSKEGON, MI 49440
- **Mailing address phone:** (231) 375-5356
- **Mailing address fax:** (231) 756-7211

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101Y00000X | Counselor | — | NULL | — |
| 101Y00000X | Counselor | — | — | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 05/11/2007
- **Last updated:** 01/03/2020