Healthcare Provider Details

I. General information

NPI: 1912658865
Provider Name (Legal Business Name): SPECTRUM HEALTH - LEFFINGWELL AVENUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LEFFINGWELL AVE NE
GRAND RAPIDS MI
49525-6438
US

IV. Provider business mailing address

1001 LEFFINGWELL AVE NE
GRAND RAPIDS MI
49525-6438
US

V. Phone/Fax

Practice location:
  • Phone: 866-989-7999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN ZANK
Title or Position: ADMINISTRATION - RNC
Credential:
Phone: 616-267-4758