Provider Demographics
NPI:1760286751
Name:WEST MICHIGAN RESPITE LLC
Entity type:Organization
Organization Name:WEST MICHIGAN RESPITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-907-2816
Mailing Address - Street 1:2233 E MARRISON RD
Mailing Address - Street 2:
Mailing Address - City:CUSTER
Mailing Address - State:MI
Mailing Address - Zip Code:49405-9736
Mailing Address - Country:US
Mailing Address - Phone:231-907-2816
Mailing Address - Fax:
Practice Address - Street 1:2233 E MARRISON RD
Practice Address - Street 2:
Practice Address - City:CUSTER
Practice Address - State:MI
Practice Address - Zip Code:49405-9736
Practice Address - Country:US
Practice Address - Phone:231-907-2816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care