Healthcare Provider Details

I. General information

NPI: 1073506473
Provider Name (Legal Business Name): CHRISTIAN REST HOME ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EDISON AVE NW
GRAND RAPIDS MI
49504-3918
US

IV. Provider business mailing address

1000 EDISON AVE NW
GRAND RAPIDS MI
49504-3918
US

V. Phone/Fax

Practice location:
  • Phone: 616-453-2475
  • Fax: 616-453-2645
Mailing address:
  • Phone: 616-453-2475
  • Fax: 616-453-2645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number414020
License Number StateMI

VIII. Authorized Official

Name: MR. JAMES HORJUS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 616-453-2475