| Jumpstart 2 Recovery Llc | |
|
1345 Monroe Ave Nw Ste 322 Grand Rapids MI 49505-4674 | |
| (616) 308-3800 | |
| Not Available |
| Full Name | Jumpstart 2 Recovery Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1345 Monroe Ave Nw Ste 322, Grand Rapids, Michigan |
| Authorized Official Name and Position | Gwendolyn Thompson (CREDENTIALING) |
| Authorized Official Contact | 9196152371 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jumpstart 2 Recovery Llc 1345 Monroe Ave Nw Ste 322 Grand Rapids MI 49505-4674 Ph: (616) 308-3800 | Jumpstart 2 Recovery Llc 1345 Monroe Ave Nw Ste 322 Grand Rapids MI 49505-4674 Ph: (616) 308-3800 |
| NPI Number | 1114405958 |
|---|---|
| Provider Enumeration Date | 08/03/2018 |
| Last Update Date | 01/19/2025 |
| Certification Date | 01/19/2025 |
| Medicare PECOS PAC ID | 3870024052 |
|---|---|
| Medicare Enrollment ID | O20240927002695 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114405958 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | 6801097891 (Michigan) | Primary |
| Provider Name | Alexander Timothy Thompson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265919849 PECOS PAC ID: 6103238654 Enrollment ID: I20201208000226 |
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