Healthcare Provider Details

I. General information

NPI: 1285019802
Provider Name (Legal Business Name): MARY FREE BED SUB-ACUTE REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WEALTHY ST SE 5TH FLOOR
GRAND RAPIDS MI
49503-5247
US

IV. Provider business mailing address

235 WEALTHY ST SE 5TH FLOOR
GRAND RAPIDS MI
49503-5247
US

V. Phone/Fax

Practice location:
  • Phone: 616-840-8330
  • Fax:
Mailing address:
  • Phone: 616-840-8330
  • 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: PAMELA LATOVICK
Title or Position: VP REIMBURSEMENT
Credential:
Phone: 734-343-6628