Healthcare Provider Details

I. General information

NPI: 1689748972
Provider Name (Legal Business Name): HARBOR REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 JEFFERSON AVE SE
GRAND RAPIDS MI
49503-4304
US

IV. Provider business mailing address

PO BOX 150272
GRAND RAPIDS MI
49515-0272
US

V. Phone/Fax

Practice location:
  • Phone: 616-643-0833
  • Fax: 616-643-0844
Mailing address:
  • Phone: 616-643-0833
  • Fax: 616-643-0844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. THERESA RENKER
Title or Position: DIRECTOR
Credential: MS CCC SLP
Phone: 616-643-0833