Provider Demographics
NPI:1215103460
Name:GENESIS NON PROFIT HOUSING CORP.- HERON COURT
Entity type:Organization
Organization Name:GENESIS NON PROFIT HOUSING CORP.- HERON COURT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATIVE GURU
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERKODDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-988-2897
Mailing Address - Street 1:528 BRIDGE ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5349
Mailing Address - Country:US
Mailing Address - Phone:616-988-2897
Mailing Address - Fax:
Practice Address - Street 1:1138 HERON CT NE OFC
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5802
Practice Address - Country:US
Practice Address - Phone:616-855-0017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS NON PROFIT CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management