Organization
SPECTRUM HEALTH KENT COMMUNITY CAMPUS
Active
Other names
Spectrum Health Rehab & Nursing Center Fuller
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN SMITH (VP FINANCE)
(616) 486-2672
Entity
Organization
Contact information
Practice address
750 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
(616) 391-4200
(616) 486-2419
Mailing address
750 FULLER AVE NE, GRAND RAPIDS, MI 49503-1918
(616) 391-4200
(616) 643-9060
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
413090
MI
314000000X
Skilled Nursing Facility
Primary
413090
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09978
BCBS
MI
05
—
624151184
—
MI
Enumeration date
12/05/2005
Last updated
03/26/2015
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