MEDICARE: CHRISTIAN REST HOME ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	414020	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073506473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN REST HOME ASSOCIATION

Provider Business Mailing Address
First Line	:	1000 EDISON AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-3918
Country	:	US
Telephone Number	:	616-453-2475
Fax Number	:	616-453-2645

Provider Business Practice Location Address
First Line	:	1000 EDISON AVE NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49504-3918
Country	:	US
Telephone Number	:	616-453-2475
Fax Number	:	616-453-2645

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. JAMES HORJUS
Credential	:
Telephone Number	:	616-453-2475

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	06/13/2008

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