Healthcare Provider Details

I. General information

NPI: 1508980285
Provider Name (Legal Business Name): PROFESSIONAL REHABILITATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 02/08/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 E BELTLINE AVE NE
GRAND RAPIDS MI
49525-9802
US

IV. Provider business mailing address

4234 CASCADE RD SE
GRAND RAPIDS MI
49546-8384
US

V. Phone/Fax

Practice location:
  • Phone: 616-202-4840
  • Fax:
Mailing address:
  • Phone: 616-202-4840
  • Fax: 888-371-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KRISTIAN SKOGEN
Title or Position: PRESIDENT
Credential:
Phone: 616-202-4840