# GRAND RIVER REHABILITATION LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124519707
- **Authorized official:** DR. ADAM JOSEPH RUSH MD (OWNER)
- **Authorized official phone:** (616) 780-7389

## Contact information

- **Practice address:** 412 PLYMOUTH AVE NE, GRAND RAPIDS, MI 49505-6028
- **Practice address phone:** (616) 780-2324
- **Practice address fax:** (877) 991-4975
- **Mailing address:** 412 PLYMOUTH AVE NE, GRAND RAPIDS, MI 49505-6028
- **Mailing address phone:** (616) 780-2324
- **Mailing address fax:** (877) 991-4975

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | 4301091218 | MI | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 4301091218 | MI | Yes |
| 2081P0010X | Pediatric Rehabilitation Medicine Physician | 4301091218 | MI | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |

## Other

- **Enumeration date:** 05/19/2018
- **Last updated:** 05/12/2023