MEDICARE: SPECTRUM HEALTH CONTINUING CARE

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	313M00000X	Nursing Facility/Intermediate Care Facility	414090	MI
2	314000000X	Skilled Nursing Facility	414090	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
2	09613	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1750365532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM HEALTH CONTINUING CARE

Provider Business Mailing Address
First Line	:	750 FULLER AVE NE
Second Line	:	MC 160
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-1918
Country	:	US
Telephone Number	:	616-643-9083
Fax Number	:	616-643-9060

Provider Business Practice Location Address
First Line	:	4118 KALAMAZOO AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-3605
Country	:	US
Telephone Number	:	616-455-7300
Fax Number	:	616-455-7154

Authorized Official
Title or Position	:	CFO
Name	:	MR. MATTHEW E COX
Credential	:
Telephone Number	:	616-391-1663

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	10/03/2023

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