Individual
RAEKESHA LACHELLE MCMILLIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
820 WATKINS ST SE, GRAND RAPIDS, MI 49507-1345
(616) 427-4570
Mailing address
1232 KALAMAZOO AVE SE, GRAND RAPIDS, MI 49507-1923
(616) 427-4570
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
AS410388538
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
W314730488684
—
MI
Enumeration date
08/22/2017
Last updated
08/22/2017
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