RAEKESHA LACHELLE MCMILLIAN (NPI# 1053837922) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053837922 |
| Entity Type | Individual |
| Full Name | RAEKESHA LACHELLE MCMILLIAN |
| Practice Address |
820 Watkins St Se Grand Rapids MI 49507-1345 |
| Mailing Address |
1232 Kalamazoo Ave Se Grand Rapids MI 49507-1923 |
| Practice Telephone | 6164274570 |
| Mailing Telephone | 6164274570 |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2017-08-22 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0630X |
Assisted Living Facility Specialization: Assisted Living, Behavioral Disturbances |
AS410388538 | MI | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | W314730488684 | 05 |
| Street Address |
820 WATKINS ST SE |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49507-1345 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487156956 | Kristen Zvirbulis Keeter | Physical Therapist | 625 Kenmoor Ave. Se Ste 306, Grand Rapids, MI 49507 | 2018-03-01 |
| 1508371758 | Vanessa Woodard | Case Manager/Care Coordinator | 1939 S. Division Ave., Grand Rapids, MI 49507 | 2017-12-11 |
| 1306350624 | Courtney Nicole Porter | Social Worker | 1979 S Division Ave., Grand Rapids, MI 49507 | 2017-11-22 |
| 1518496900 | 733 Prince LLC | Custodial Care Facility | 733 Prince St Se, Grand Rapids, MI 49507 | 2017-06-08 |
| 1720515406 | Tiffanie Ryder | Massage Therapist | 1110 Merrified St, Grand Rapids, MI 49507 | 2017-05-12 |
| 1619404308 | Shedrice's Afc | Respite Care | 246 Powell Se Ave, Grand Rapids, MI 49507 | 2017-05-12 |
| 1992171748 | Richard Lavell Flowers | Non-emergency Medical Transport (VAN) | 1447 Elliott, Grand Rapids, MI 49507 | 2015-08-17 |
| 1982096087 | Jordana Seebeck | Social Worker | 1939 S. Division Se, Grand Rapids, MI 49507 | 2015-02-26 |
| 1083973135 | Carla May Waite | Social Worker | 1939 South Division, Grand Rapids, MI 49507 | 2012-05-10 |
| 1740550037 | Jamie Lee Dalton | Social Worker | 2017 College Ave Se, Grand Rapids, MI 49507 | 2012-01-04 |
| Find all providers in zip 49507 | ||||
| Taxonomy Code | 3104A0630X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Behavioral Disturbances |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being. This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770131344 | Garth Hutton | Assisted Living Facility | 1404 Territorial Rd W, Battle Creek, MI 49015-2751 | 2019-08-27 |
| 1669968129 | Lake Shore Afc, LLC | Assisted Living Facility | 2480 Tonawanda Lake Rd, Grawn, MI 49637-9615 | 2018-07-09 |
| 1942691191 | Stoneridge Adult Foster Care | Assisted Living Facility | 4825 Fruin Rd, Bellevue, MI 49021-8209 | 2015-02-10 |
| 1942605746 | D & J Home Care 3, LLC | Assisted Living Facility | 33255 26 Mile Rd, Lenox, MI 48048-2904 | 2014-10-23 |
| 1043614852 | D & J Home Care, Inc. | Assisted Living Facility | 5485 Smiths Creek Rd, Kimball, MI 48074-3811 | 2014-10-22 |
| 1689004921 | Niche Aging Center | Assisted Living Facility | 3405 E Midland Rd, Bay City, MI 48706-2825 | 2013-11-23 |
| 1992135313 | Bavarian Comfort Care | Assisted Living Facility | 5366 W Rolling Hills Dr, Bridgeport, MI 48722-9671 | 2013-11-21 |
| 1184803678 | Dianes Sweet Home,inc | Assisted Living Facility | 7750 Carpenter Rd, Ypsilanti, MI 48197-8847 | 2007-10-31 |
| 1760677751 | Mastrofrancesco Afc Inc | Assisted Living Facility | 18787 Ray St, Riverview, MI 48193-7428 | 2007-09-12 |
| 1295800779 | Samaritan Homes Inc | Assisted Living Facility | 25160 Lahser Rd Ste 221, Southfield, MI 48034-6302 | 2006-11-21 |
| Find all providers with the same taxonomy | ||||
| City | GRAND RAPIDS |
| Zip Code | 49507 |
Please comment or provide details below to improve the information on RAEKESHA LACHELLE MCMILLIAN.
| 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.