Healthcare Provider Details

I. General information

NPI: 1508030479
Provider Name (Legal Business Name): SPECTRUM HEALTH CONTINUING CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2001
US

IV. Provider business mailing address

1255 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2001
US

V. Phone/Fax

Practice location:
  • Phone: 616-486-3950
  • Fax: 616-486-3940
Mailing address:
  • Phone: 616-486-3950
  • Fax: 616-486-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number5301008849
License Number StateMI

VIII. Authorized Official

Name: MARK GUZICKI
Title or Position: VP, COMM. & HOME BASED SERVICE
Credential: RN
Phone: 616-486-3955