| A Grand Rapids Senior Social Exchange And Adult Day Center | |
|
3212 Eastern Ave Se Grand Rapids MI 49508 | |
| (616) 329-4101 | |
| Not Available |
| Full Name | A Grand Rapids Senior Social Exchange And Adult Day Center |
|---|---|
| Speciality | Social Worker |
| Location | 3212 Eastern Ave Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Jodie Lynn Robertson (OWNER) |
| Authorized Official Contact | 6163294101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| A Grand Rapids Senior Social Exchange And Adult Day Center Po Box 7004 Grand Rapids MI 49510-7004 Ph: (616) 329-4101 | A Grand Rapids Senior Social Exchange And Adult Day Center 3212 Eastern Ave Se Grand Rapids MI 49508 Ph: (616) 329-4101 |
| NPI Number | 1881102788 |
|---|---|
| Provider Enumeration Date | 01/14/2018 |
| Last Update Date | 07/02/2018 |
| Medicare PECOS PAC ID | 6002177441 |
|---|---|
| Medicare Enrollment ID | O20180228001728 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881102788 | NPI | - | NPPES |
| Provider Name | Deborah L Jandle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295841872 PECOS PAC ID: 1951297779 Enrollment ID: I20040226000986 |
| Provider Name | Angela Embree |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225407554 PECOS PAC ID: 2567739386 Enrollment ID: I20180628002244 |
| Provider Name | Cynthia L Gladyness |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184937765 PECOS PAC ID: 1658621776 Enrollment ID: I20180911000335 |
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