Provider Demographics
NPI:1689000952
Name:ARTHUR, MARLENE
Entity type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:
Last Name:ARTHUR
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 1:356 CLEVELAND ST W
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-9673
Mailing Address - Country:US
Mailing Address - Phone:616-837-1106
Mailing Address - Fax:616-837-1506
Practice Address - Street 1:356 CLEVELAND ST W
Practice Address - Street 2:
Practice Address - City:COOPERSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49404-9673
Practice Address - Country:US
Practice Address - Phone:616-837-1106
Practice Address - Fax:616-837-1506
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAF700082027310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility