Provider Demographics
NPI:1124498837
Name:FOURCHA, DARSHETHIA
Entity type:Individual
Prefix:
First Name:DARSHETHIA
Middle Name:
Last Name:FOURCHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 HOVEY ST SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-6228
Mailing Address - Country:US
Mailing Address - Phone:616-929-3204
Mailing Address - Fax:
Practice Address - Street 1:816 HOVEY ST SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-6228
Practice Address - Country:US
Practice Address - Phone:616-929-3204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI193400000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker