Provider Demographics
NPI:1407727837
Name:HALLADA, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HALLADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4712 RICHMOND ST NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-1199
Mailing Address - Country:US
Mailing Address - Phone:616-212-3888
Mailing Address - Fax:
Practice Address - Street 1:4712 RICHMOND ST NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-1199
Practice Address - Country:US
Practice Address - Phone:616-212-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health