Healthcare Provider Details

I. General information

NPI: 1215723853
Provider Name (Legal Business Name): OPTALIS BELTLINE OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 E BELTLINE AVE SE
GRAND RAPIDS MI
49546-5906
US

IV. Provider business mailing address

2320 E BELTLINE AVE SE
GRAND RAPIDS MI
49546-5906
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-3000
  • Fax:
Mailing address:
  • Phone: 616-949-3000
  • Fax:

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: RAJ PATEL
Title or Position: CEO
Credential:
Phone: 248-692-4355