Healthcare Provider Details

I. General information

NPI: 1750365532
Provider Name (Legal Business Name): SPECTRUM HEALTH CONTINUING CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4118 KALAMAZOO AVE SE
GRAND RAPIDS MI
49508-3605
US

IV. Provider business mailing address

750 FULLER AVE NE MC 160
GRAND RAPIDS MI
49503-1918
US

V. Phone/Fax

Practice location:
  • Phone: 616-455-7300
  • Fax: 616-455-7154
Mailing address:
  • Phone: 616-643-9083
  • Fax: 616-643-9060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number414090
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number414090
License Number StateMI

VIII. Authorized Official

Name: MR. MATTHEW E COX
Title or Position: CFO
Credential:
Phone: 616-391-1663