Individual
STACIA NICHOLE LARIVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
105 VINE ST, CADILLAC, MI 49601-2435
(231) 884-1988
Mailing address
105 VINE ST, CADILLAC, MI 49601-2435
(231) 884-1988
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AF830403510
MI
Other
Enumeration date
08/24/2020
Last updated
08/24/2020
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