Healthcare Provider Details

I. General information

NPI: 1457546111
Provider Name (Legal Business Name): GRAND RIVER HEALTH SYSTEM CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 PARK LN
CHILLICOTHEE MO
64601-1551
US

IV. Provider business mailing address

498 PARK LN
CHILLICOTHEE MO
64601-1551
US

V. Phone/Fax

Practice location:
  • Phone: 660-646-2199
  • Fax:
Mailing address:
  • Phone: 660-646-2199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: BRIAN J JOHNSTON
Title or Position: CEO
Credential:
Phone: 660-646-1480