Healthcare Provider Details

I. General information

NPI: 1821362278
Provider Name (Legal Business Name): PRIMARY REHAB CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2012
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 28TH ST SE STE 7
GRAND RAPIDS MI
49508
US

IV. Provider business mailing address

2055 28TH ST SE STE 7
GRAND RAPIDS MI
49508-1582
US

V. Phone/Fax

Practice location:
  • Phone: 616-245-7013
  • Fax: 616-245-7018
Mailing address:
  • Phone: 616-245-7013
  • Fax: 616-245-7018

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: MRS. MARICARMEN RAMIREZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 616-245-7013