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1400 Leonard Street Ne Grand Rapids MI 49505-5515 | |
| (616) 954-1991 | |
| (616) 954-1998 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 1400 Leonard Street Ne, Grand Rapids, Michigan |
| Authorized Official Name and Position | Tasha Blackmon (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6167762121 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
100 Cherry St Se Grand Rapids MI 49503-4748 Ph: (616) 965-8200 | 1400 Leonard Street Ne Grand Rapids MI 49505-5515 Ph: (616) 954-1991 |
| NPI Number | 1043592629 |
|---|---|
| Provider Enumeration Date | 09/09/2011 |
| Last Update Date | 10/01/2021 |
| Certification Date | 10/01/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043592629 | NPI | - | NPPES |
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