Individual
JACOB SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1490 E BELTLINE AVE SE, GRAND RAPIDS, MI 49506-4336
(616) 957-4057
Mailing address
1490 E BELTLINE AVE SE, GRAND RAPIDS, MI 49506-4336
(616) 957-4057
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
38-2481067
MI
Other
Enumeration date
12/10/2013
Last updated
12/10/2013
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