Healthcare Provider Details

I. General information

NPI: 1306794763
Provider Name (Legal Business Name): VICARE REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 WOODGLEN ST NW
GRAND RAPIDS MI
49504-3607
US

IV. Provider business mailing address

2924 WOODGLEN ST NW
GRAND RAPIDS MI
49504-3607
US

V. Phone/Fax

Practice location:
  • Phone: 616-914-9618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN LEO VICARI
Title or Position: OWNER
Credential: DPT
Phone: 616-914-9618