Jerry's Dream Adult Homes

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

AS410269764 Issued in MI

Legal business name

JERRY'S DREAM ADULT HOMES

Practice address

1124 W Leonard CT NW
Grand Rapids, MI 49534-6835

Phone

(616) 735-4681

NPI assigned

May 31, 2017

Last updated

May 31, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Vickie Runyon

Title

Owner

Phone

(616) 293-7198

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1496188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496188800000",
    "number": "1689102931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1086",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495011086",
            "telephone_number": "616-293-7198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 W LEONARD CT NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495346835",
            "telephone_number": "616-735-4681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY'S DREAM ADULT HOMES",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-31",
        "last_updated": "2017-05-31",
        "status": "A",
        "authorized_official_last_name": "RUNYON",
        "authorized_official_first_name": "VICKIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-293-7198"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MI",
            "license": "AS410269763",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "MI",
            "license": "AS410269764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1174395",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9493156",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grace Elizabeth Jerome, LLMSW
• Carrie J Jerow, MPAS, PA-C
• Jerry B Vanleeuwen PHD PC
• Jerry B. Mulder DDS PLC (A Life of Smiles)
• Jerry Burgess Mulder
• Todd Palmer Jervis, RPH
• Mark Jesin, DDS
• Christy Ann Jesse
• Jessica Crafton LLC (Balanced Babies Therapy Services)
• Jessica Evans CCC-SLP Inc.

• Adult Care Home Facility in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Adult Care Home Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.