Individual
TENAGNE MENGISTU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
604 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-5218
(616) 589-4609
Mailing address
604 JEFFERSON AVE SE, GRAND RAPIDS, MI 49503-5218
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
AF410315360
MI
Other
Enumeration date
05/25/2017
Last updated
05/25/2017
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