Healthcare Provider Details

I. General information

NPI: 1679749303
Provider Name (Legal Business Name): MARY FREE BED HOSPITAL AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WEALTHY ST SE
GRAND RAPIDS MI
49503-5247
US

IV. Provider business mailing address

235 WEALTHY ST SE
GRAND RAPIDS MI
49503-5247
US

V. Phone/Fax

Practice location:
  • Phone: 616-242-0403
  • Fax: 616-242-9113
Mailing address:
  • Phone: 616-242-0403
  • Fax: 616-242-9113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDALL DENEFF
Title or Position: VP CHIEF FINANCIAL OFFICER
Credential:
Phone: 616-242-0403