Raekesha Lachelle McMillian

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

License

AS410388538 Issued in MI

Practice address

820 Watkins St SE
Grand Rapids, MI 49507-1345

Phone

(616) 427-4570

NPI assigned

Aug 22, 2017

Last updated

Aug 22, 2017By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community

  • In Home Supportive Care Agency
  • Grand Rapids, MI
  • NPI 1396404240
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503360000000",
    "number": "1053837922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1232 KALAMAZOO AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495071923",
            "telephone_number": "616-427-4570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 WATKINS ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495071345",
            "telephone_number": "616-427-4570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMILLIAN",
        "first_name": "RAEKESHA",
        "middle_name": "LACHELLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-22",
        "last_updated": "2017-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": "MI",
            "license": "AS410388538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "W314730488684",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren McMahon, MPT
• Michelle Ann McMahon, LMSW
• Alyssa McMandon, DO
• April D McManes, PA-C
• Curtis McMann, PA-C
• Satara Alicia McMillian
• Tara Rachelle McMillin, PHARMD
• Shannon Marie McMullin, LLMSW
• Shan Michael McMurphy, RPH
• Toni McMurphy, OTR

• Assisted Living Facility (Behavioral Disturbances) in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Assisted Living Facility (Behavioral Disturbances) in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.