Individual
ALLEN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
GENERAL DELIVERY, GRAND RAPIDS, MI 49501-9999
(616) 954-5095
Mailing address
GENERAL DELIVERY, GRAND RAPIDS, MI 49501-9999
(616) 954-5095
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
J250051155983
MI
Other
Enumeration date
07/23/2015
Last updated
07/23/2015
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