Provider Demographics
NPI:1992987176
Name:KINGSBURY PLACE
Entity type:Organization
Organization Name:KINGSBURY PLACE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADM ASST
Authorized Official - Prefix:MS
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 1:730 N CENTER CT NW
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8247
Mailing Address - Country:US
Mailing Address - Phone:616-988-4737
Mailing Address - Fax:
Practice Address - Street 1:730 N CENTER CT NW
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49544-8247
Practice Address - Country:US
Practice Address - Phone:616-988-4737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS NON-PROFIT HOUSING CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management