STATE OF MICHIGAN


Address: 3000 Monroe Ave Ne, Grand Rapids, MI 49505-3313
Phone: 6163645355

STATE OF MICHIGAN (NPI# 1093819229) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1093819229
Entity Type Organization
Organization Name STATE OF MICHIGAN
Other Organization Name GRAND RAPIDS HOME FOR VETERANS
Practice Address 3000 Monroe Ave Ne
Grand Rapids
MI 49505-3313
Practice Telephone 6163645355
Practice Fax Number 6163645260
Mailing Telephone 6163645355
Mailing Fax Number 6163645260
Enumeration Date 2006-09-08
Last Update Date 2016-10-19
Authorized Official Name MR. JOHN WILLIAM CARLSON JR. (DIRECTOR OF PHARMACY)
Authorized Official Telephone 6163645355
Authorized Official Credential RPH
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 3336L0003X Pharmacy
Specialization: Long Term Care Pharmacy
5301000666 MI Suppliers

Other Provider Identifier

State Issuer Identifier Type Code
MI PHARMACY ID NUMBER 5301000666 01
MI NABP NUMBER 2353631 01

Other Provider/Organization Names

Other Name Type Code
Grand Rapids Home for Veterans Doing Business As Name - Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1831739010 State of Michigan Rehabilitation Counselor 201 N Washington Sq Fl 2, Lansing, MI 48933-1328 2020-01-15
1942254321 State of Michigan Pharmacy 8303 Platt Rd, Saline, MI 48176-9773 2006-05-20
1366912669 State of Michigan Skilled Nursing Facility 425 Fisher St, Marquette, MI 49855-4521 2018-11-29
1952704843 State of Michigan Pharmacy 425 Fisher St, Marquette, MI 49855-4521 2014-10-06
1235208182 State of Michigan Pharmacy 1400 W Pickard St, Mt Pleasant, MI 48858-1364 2006-11-07
1053480905 State of Michigan Pharmacy 18471 Haggerty Rd, Northville, MI 48168-8513 2006-11-07
1194736587 State of Michigan Pharmacy 1312 Oakland Dr, Kalamazoo, MI 49008-1205 2006-08-10
1508883299 State of Michigan Pharmacy 30901 Palmer Rd, Westland, MI 48186-5389 2006-07-17
1003859380 State of Michigan Pharmacy 8303 Platt Rd, Saline, MI 48176-9773 2006-06-14

Office Location

Street Address 3000 MONROE AVE NE
City GRAND RAPIDS
State MI
Zip Code 49505-3313

Providers in the same location

NPI Name Taxonomy Address Enumeration
1710989298 State of Michigan Office of Financial Management Nursing Facility/Intermediate Care Facility 3000 Monroe Ave Ne, Grand Rapids, MI 49505-3397 2005-08-15
1003462995 Ashleigh Nicole Miling Occupational Therapy Assistant 3000 Monroe Ave Ne, Grand Rapids, MI 49505-3313 2019-08-15
1245796739 Takashi Okada Occupational Therapist 3000 Monroe Ave Ne, Grand Rapids, MI 49505-3313 2019-02-20
1104319037 Jill Emens Occupational Therapist 3000 Monroe Ave Ne, Grand Rapids, MI 49505-3313 2018-06-14
1326530189 Mandisa Grable Occupational Therapist 3000 Monroe Ave Ne, Grand Rapids, MI 49505-3313 2018-06-06
1790277275 Sharayu Bell Physical Therapist 3000 Monroe Ave Ne, Grand Rapids, MI 49505-3313 2018-05-31
1437655313 Jenny Eshleman-hall Gibb Physical Therapist 3000 Monroe Ave Ne, Grand Rapids, MI 49505-3313 2018-04-01
1760999718 Saadatu White Occupational Therapist 3000 Monroe Ave Ne, Grand Rapids, MI 49505-3313 2017-12-29
1588170856 Jessica Craft Physical Therapist 3000 Monroe Ave Ne, Grand Rapids, MI 49505-3313 2017-12-21
1033624242 Sunil Paingol Speech-Language Pathologist 3000 Monroe Ave Ne, Grand Rapids, MI 49505-3313 2017-12-11
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1285276097 Molly Beth Kerkstra Home Health Aide 1115 Ball Ave Nw, Grand Rapids, MI 49505 2019-10-14
1154849677 Roshawn Nichol Whitley Technician 891 Maryland Ave, Grand Rapids, MI 49505 2017-09-05
1447778923 Kelly Benzin-brinks Social Worker 1965 3 Mile Rd Ne, Grand Rapids, MI 49505 2017-09-05
1033560404 Taylor Nolan Boyd Speech-Language Pathologist 400 Ann St Ne Ste 106a, Grand Rapids, MI 49505 2016-06-28
1023465002 Calvin Athy Counselor 1101 Ballave Ne, Grand Rapids, MI 49505 2016-05-19
1821456682 Kelly Van Huisen Counselor 1115 Ball Avenue Ne, Building B, Grand Rapids, MI 49505 2016-02-08
1780051102 Mark Squeteri Social Worker 1345 Monroe Ave Nw Ste 234, Grand Rapids, MI 49505 2015-09-02
1346637337 Shelby Fullington Social Worker 1011 Ball Ave Ne, Grand Rapids, MI 49505 2015-04-17
1457745325 Lester Anderson II Social Worker 1115 Ball Ave, Grand Rapids, MI 49505 2015-03-27
1730570151 Nicole Brown Counselor 1345 Monroe Ave Nw Ste 204, Grand Rapids, MI 49505 2015-02-06
Find all providers in zip 49505

Taxonomy Information

Taxonomy Code 3336L0003X
Grouping Suppliers
Classification Pharmacy
Specialization Long Term Care Pharmacy

Taxonomy Definition

A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.
Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1225688229 Guardian Pharmacy of Grand Rapids, LLC Pharmacy 2930 29th St Se, Grand Rapids, MI 49512-1723 2019-09-12
1013493733 Pharmascript of Michigan Gr LLC Pharmacy 2661 29th St. Se Suite A, Grand Rapids, MI 49512 2018-07-16
1093229361 Horizon Pharmacy Ltc, LLC Pharmacy 4150 Kalamazoo Ave Se, Grand Rapids, MI 49508-3605 2017-11-25
1083849640 Pca-corrections LLC Pharmacy 4665 44th St Se Ste A1106, Grand Rapids, MI 49512-4052 2009-05-26
1437252475 Tcpi Acquisition LLC Pharmacy 3650 Broadmoor Ave Se, Suite 108, Grand Rapids, MI 49512-3925 2006-09-06
1356981922 Home Town Pharmacy Inc Pharmacy 4252 Kalamazoo Ave Se, Grand Rapids, MI 49508-3607 2020-01-13

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1437772159 Krx Medication Consultants Pharmacy 8266 Fernwood St, Augusta, MI 49012 2020-05-28
1235751306 Ypsilanti Family Pharmacy, Inc. Pharmacy 2287 Ellsworth Rd Ste A, Ypsilanti, MI 48197-4805 2020-05-12
1366082935 Home Town Pharmacy Inc Pharmacy 1114 W South Airport Rd, Traverse City, MI 49686-4739 2020-01-13
1619510328 Great Lakes Pharmacies I Inc Pharmacy 6213 Chicago Rd Ste 200, Warren, MI 48092-1697 2019-10-25
1710520143 H & L Drugs Inc Pharmacy 1455 S Lapeer Rd Ste 101, Lake Orion, MI 48360-1468 2019-10-17
1457905259 Senior Care Rx LLC Pharmacy 24293 Telegraph Rd Ste 130, Southfield, MI 48033-7924 2019-07-30
1063071637 Smart Rx LLC Pharmacy 25464 Van Born Rd, Dearborn Heights, MI 48125 2019-06-07
1457812117 Pharmtek LLC Pharmacy 3307 Orchard Lake Rd, Keego Harbor, MI 48320-1308 2019-03-26
1801350772 Prestige Specialty Pharmacy 2 Pharmacy 31700 Van Dyke Ave Ste B, Warren, MI 48093-7949 2019-01-24
1194296707 Palmer Ltc Pharmacy LLC Pharmacy 4020 Venoy Rd Ste 900b, Wayne, MI 48184-4818 2018-12-07
Find all providers with the same taxonomy

Competitor

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City GRAND RAPIDS
Zip Code 49505

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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