Individual
JACKLINE ANDREW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
716 IDAHO AVE, PORTAGE, MI 49024-1235
(616) 528-0138
Mailing address
716 IDAHO AVE, PORTAGE, MI 49024-1235
(616) 528-0138
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AS390418237
MI
Other
Enumeration date
06/10/2025
Last updated
06/10/2025
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