=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427444595
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPECTRUM HEALTH CONTINUING CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2015
-----------------------------------------------------
Last Update Date | 06/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 STATE ST SUITE 3
-----------------------------------------------------
City | NEWAYGO
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-355-5300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 MICHIGAN ST NE MC 845
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49503-1918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 616-486-2404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTROLLER
-----------------------------------------------------
Name | KEVIN P SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 616-486-6790
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------