Healthcare Provider Details

I. General information

NPI: 1053550590
Provider Name (Legal Business Name): MARY FREE BED REHABILITATION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WEALTHY ST SE
GRAND RAPIDS MI
49503-5247
US

IV. Provider business mailing address

235 WEALTHY ST SE
GRAND RAPIDS MI
49503-5247
US

V. Phone/Fax

Practice location:
  • Phone: 616-242-0300
  • Fax: 616-242-0438
Mailing address:
  • Phone: 616-242-0300
  • Fax: 616-242-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number410070
License Number StateMI

VIII. Authorized Official

Name: MR. RYAN PODVIN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 616-840-8676