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General NPI Number Information
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NPI Number | 1619162617
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Entity Type | Organization
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Legal Business Name | SPECTRUM HEALTH KELSEY
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 418 WASHINGTON ST
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City | LAKEVIEW
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State | MI
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Zip | 48850-9806
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Country | US
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Telephone | 989-352-7211
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Fax |
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Provider Business Mailing Address
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Address Line | 418 WASHINGTON ST
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City | LAKEVIEW
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State | MI
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Zip | 48850-9806
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Country | US
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Telephone | 989-352-7211
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Fax |
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Authorized Official
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Title or Position | VP FINANCE
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Name | MR. RYAN K JOHNSON
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Credential |
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Telephone | 616-225-6310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 593020
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License Number State | MI
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