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NPI Code Detail

MEDICARE: CASCADE CARE CENTER, INC

MEDICARE: CASCADE CARE CENTER, INC
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
1314000000XSkilled Nursing Facility414330MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
29828OTHERBLUE CROSS

General Provider Information

NPI Number : 1235141151
Entity Type Code : Organization
Provider Name (Legal Business Name) : CASCADE CARE CENTER, INC
Provider Business Mailing Address
First Line : 4630 PLAINFIELD AVENUE NE
Second Line : SUITE 100
City : GRAND RAPIDS
State : MI
Zip : 49525
Country : US
Telephone Number : 616-957-3957
Fax Number : 616-957-1556
Provider Business Practice Location Address
First Line : 1095 MEDICAL PARK DR SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-3607
Country : US
Telephone Number : 616-949-7220
Fax Number : 616-956-6947
Authorized Official
Title or Position : EXECUTIVE VICE PRESIDENT / CFO
Name : MR. J LINDSEY DOOD
Credential :
Telephone Number : 616-975-5287
Provider Enumeration Date : 08/12/2006
Last Update Date : 12/10/2008

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Directions to “CASCADE CARE CENTER, INC ” Practice Location

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