Provider Demographics
NPI:1316644297
Name:TAYLOR, DAVID PAUL (HOME CARE GIVER)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:HOME CARE GIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10132 W LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651-8810
Mailing Address - Country:US
Mailing Address - Phone:616-232-9508
Mailing Address - Fax:907-313-1400
Practice Address - Street 1:10132 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MI
Practice Address - Zip Code:49651-8810
Practice Address - Country:US
Practice Address - Phone:616-227-1391
Practice Address - Fax:907-313-1400
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1316644297376K00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI61-2105919OtherPRIORITY HEALTH
MI61-2105919Medicaid