Individual
ROSE MARIE BOUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12700 LINCOLN LAKE AVE, GOWEN, MI 49326
(231) 580-4533
(616) 712-6002
Mailing address
12700 LINCOLN LAKE AVE, GOWEN, MI 49326-9403
(231) 580-4533
(616) 712-6002
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AF410395782
MI
Other
Enumeration date
11/08/2018
Last updated
11/08/2018
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