Provider Demographics
NPI:1992138184
Name:DAVID'S HOUSE MINISTRIES
Entity type:Organization
Organization Name:DAVID'S HOUSE MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-726-1702
Mailing Address - Street 1:2390 BANNER DR SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-1930
Mailing Address - Country:US
Mailing Address - Phone:616-247-7861
Mailing Address - Fax:
Practice Address - Street 1:2390 BANNER DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-1930
Practice Address - Country:US
Practice Address - Phone:616-247-7861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3783444Medicaid