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General NPI Number Information
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NPI Number | 1649655564
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Entity Type | Organization
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Legal Business Name | COGNITIVE AND THERAPEUTIC COMPREHENSIVE HOME HEALTH
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 800 MONROE AVE NW SUITE 102
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1445
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Country | US
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Telephone | 616-421-4800
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Fax | 616-499-7083
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Provider Business Mailing Address
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Address Line | 800 MONROE AVE NW SUITE 102
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1445
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Country | US
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Telephone | 616-421-4800
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Fax | 616-499-7083
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Authorized Official
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Title or Position | CEO
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Name | MR. TIMOTHY ROLAND FRAIN
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Credential |
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Telephone | 616-719-9992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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