Edward A Booker Jr.

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

410376 Issued in MI

Practice address

1740 Willard Ave SE
Grand Rapids, MI 49507-2662

Phone

(616) 886-6917

NPI assigned

Nov 7, 2012

Last updated

Nov 7, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1352246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352246400000",
    "number": "1588918841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2646 JUNIPER AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494248246",
            "telephone_number": "616-886-6917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1740 WILLARD AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495072662",
            "telephone_number": "616-886-6917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOKER",
        "first_name": "EDWARD",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-11-07",
        "last_updated": "2012-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MI",
            "license": "410376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Paul Bonter, PHARMD
• Danielle N Boog, MS, OTR/L
• Jadyn Boogaard
• Beth Ann Boogholt, M.S., BCBA, LLP, LBA
• Booker Behavior Therapy LLC
• Marilyn Booker, MA, LSC, LLPC
• Lisa Marie Boomers, LLPC
• Sarah Elena Boomgaard-Hughes
• Andrea Boomgaard, LLMSW
• Donald Boomgaard

• Substance Abuse Rehabilitation Facility in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Substance Abuse Rehabilitation Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2012; 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.