Healthcare Provider Details

I. General information

NPI: 1275740185
Provider Name (Legal Business Name): JOHN M RHODES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 CHERRY ST SE
GRAND RAPIDS MI
49506-1402
US

IV. Provider business mailing address

330 EASTERN AVE SE
GRAND RAPIDS MI
49503-4737
US

V. Phone/Fax

Practice location:
  • Phone: 616-776-0891
  • Fax: 616-233-0689
Mailing address:
  • Phone: 616-776-0891
  • Fax: 616-233-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1-01947
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: