Provider Demographics
NPI:1427514306
Name:ELDER CARE OF WEST MICHIGAN PLLC
Entity type:Organization
Organization Name:ELDER CARE OF WEST MICHIGAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:UECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-420-9404
Mailing Address - Street 1:4448 KOINONIA DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9332
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6785 MYERS LAKE AVE NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-7416
Practice Address - Country:US
Practice Address - Phone:616-366-4234
Practice Address - Fax:616-469-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-15
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty