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MICHAEL D WAGNER
NPI 1336655034
Custodial Care Facility - Adult Care Home in Grand Rapids, MI

Active since December 18, 2017
807 PINE AVE NW, GRAND RAPIDS, MI 49504(616) 776-7094(616) 776-7094 Get Directions Write a Review

NPPES record last updated: December 18, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Michael D Wagner NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MICHAEL D WAGNER (NPI 1336655034) is an individual adult care home provider in Grand Rapids, Michigan, licensed in Michigan (AF410387497) and active in the NPI registry since December 2017.

NPPES Registry Identity

NPI1336655034
Entity TypeIndividualMale
Primary Taxonomy311ZA0620X
Provider Legal NameMICHAEL D WAGNER
Location Address807 PINE AVE NWGrand Rapids, MI 49504-4340
Mailing Address807 Pine Ave NwGrand Rapids, MI 49504-4340 · (616) 776-7094
Phone(616) 776-7094
Fax(616) 776-7094
Sole ProprietorYes
Enumeration DateDecember 18, 2017
✔ NPI 1336655034 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCustodial Care Facility · Adult Care HomeNursing & Custodial Care Facilities
Taxonomy Code311ZA0620X
License✔ Licensed in MI · AF410387497
Definition
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
807 PINE AVE NW, Grand Rapids, MI 49504
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Michael Wagner's NPI number?

The NPI number for Michael Wagner is 1336655034. It was assigned to this individual provider in the NPPES registry on December 18, 2017.

Where is Michael Wagner located?

Michael Wagner practices at 807 Pine Ave NW, Grand Rapids, MI 49504. The listed phone number is (616) 776-7094.

What is Michael Wagner's specialty?

The primary specialty registered for this NPI is Custodial Care Facility, specializing in Adult Care Home, with taxonomy code 311ZA0620X.

When was this NPI record last updated?

The NPPES record for Michael Wagner was last updated on December 18, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.