Healthcare Provider Details

I. General information

NPI: 1841374139
Provider Name (Legal Business Name): GRAND RIVER HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 5TH ST
RIFLE CO
81650-2909
US

IV. Provider business mailing address

501 AIRPORT RD
RIFLE CO
81650-8510
US

V. Phone/Fax

Practice location:
  • Phone: 970-625-1514
  • Fax:
Mailing address:
  • Phone: 970-625-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. JIM CURTIS COOMBS
Title or Position: CEO
Credential:
Phone: 970-625-3792