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Organization

SALVATION ARMY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RACHAEL B BOAFO (LPN)
(616) 481-9414
Entity
Organization

Contact information

Practice address
72 SHELDON AVE SE, GRAND RAPIDS, MI 49503-4234
(616) 742-0351
Mailing address
72 SHELDON AVE SE, GRAND RAPIDS, MI 49503-4234

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary

Other

Enumeration date
07/02/2019
Last updated
07/02/2019
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