Organization
AMPLE RESIDENTIAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FADUMO OSMAN (OWNER)
(612) 402-0013
Entity
Organization
Contact information
Practice address
1164 FOREST HILL AVE SE, GRAND RAPIDS, MI 49546-3618
(612) 402-0013
Mailing address
1164 FOREST HILL AVE SE, GRAND RAPIDS, MI 49546-3618
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
08/09/2024
Last updated
08/09/2024
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