Healthcare Provider Details

I. General information

NPI: 1437226545
Provider Name (Legal Business Name): REHABILITATION RESTORATION RELAZATION STATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1152 BURTON ST SE
GRAND RAPIDS MI
49507-3359
US

IV. Provider business mailing address

1152 BURTON ST SE
GRAND RAPIDS MI
49507-3359
US

V. Phone/Fax

Practice location:
  • Phone: 616-475-7830
  • Fax:
Mailing address:
  • Phone: 616-475-7830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAULA LYNETTE HAWKINS
Title or Position: OCCUPATIONAL THERAPIST
Credential: BSOTR
Phone: 616-475-7830