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General NPI Number Information
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NPI Number | 1972315802
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Entity Type | Organization
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Legal Business Name | CHCC GRAND RAPIDS LLC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 2984 BRADFORD ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-6427
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Country | US
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Telephone | 616-317-8995
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Fax |
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Provider Business Mailing Address
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Address Line | 2984 BRADFORD ST NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-6427
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Country | US
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Telephone | 616-317-8995
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OFFICER
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Name | KATHRYN GARRY
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Credential |
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Telephone | 248-719-0388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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