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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MELANIE NICOLE DAVIS BSW (CARE COORDINATOR)
(616) 632-4407
Entity
Organization

Contact information

Practice address
1119 BURTON ST SE, GRAND RAPIDS, MI 49507-3367
(616) 632-4407
Mailing address
4490 SPRINGMONT DR SE, KENTWOOD, MI 49512-5372
(616) 632-4407

Taxonomy

Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
6802086484
MI

Other

Enumeration date
07/16/2010
Last updated
08/03/2010
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