Healthcare Provider Details

I. General information

NPI: 1083347660
Provider Name (Legal Business Name): GRAND RAPIDS OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 LEONARD ST NE
GRAND RAPIDS MI
49505-5837
US

IV. Provider business mailing address

7400 NEW LA GRANGE RD STE 400
LOUISVILLE KY
40222-4870
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-1133
  • Fax: 616-458-0743
Mailing address:
  • Phone: 502-429-8069
  • Fax: 866-360-1098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG A FLASHNER
Title or Position: LLC MEMBER
Credential:
Phone: 805-819-3351