Provider Demographics
NPI:1497645329
Name:MEKKES, RONALD L JR (COTA)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:L
Last Name:MEKKES
Suffix:JR
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 PARIS AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5404
Mailing Address - Country:US
Mailing Address - Phone:616-443-7094
Mailing Address - Fax:
Practice Address - Street 1:2000 LEONARD ST NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-3818
Practice Address - Country:US
Practice Address - Phone:616-458-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility