Healthcare Provider Details

I. General information

NPI: 1902941057
Provider Name (Legal Business Name): SPECTRUM HEALTH KELSEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 WASHINGTON AVE
LAKEVIEW MI
48850
US

IV. Provider business mailing address

PO BOX 3567
GRAND RAPIDS MI
49501-3567
US

V. Phone/Fax

Practice location:
  • Phone: 989-352-7211
  • Fax:
Mailing address:
  • Phone: 616-975-1845
  • Fax: 616-975-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number StateMI

VIII. Authorized Official

Name: DAVID J OEHRING
Title or Position: VP FINANCE CFO
Credential:
Phone: 616-225-6907