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NPI Code Detail

MEDICARE: CHRISTIAN REST HOME ASSOCIATION

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
1310400000XAssisted Living FacilityAH410236778MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AH410236778OTHERMIMICHIGAN DEPARTMENT OF HUMAN SERVICES

General Provider Information

NPI Number : 1720350341
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHRISTIAN REST HOME ASSOCIATION
Provider Business Mailing Address
First Line : 1010 EDISON AVE NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-3918
Country : US
Telephone Number : 616-453-0581
Fax Number : 616-791-0910
Provider Business Practice Location Address
First Line : 1010 EDISON AVE NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-3918
Country : US
Telephone Number : 616-453-0581
Fax Number : 616-791-0910
Authorized Official
Title or Position : ADMINISTRATOR
Name : JAMES HORJUS
Credential :
Telephone Number : 616-453-0581
Provider Enumeration Date : 01/27/2012
Last Update Date : 01/27/2012

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Directions to “CHRISTIAN REST HOME ASSOCIATION ” Practice Location

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