MEDICARE: CHEC 1 LLC

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1902761422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHEC 1 LLC

Provider Business Mailing Address
First Line	:	4910 60TH ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49512
Country	:	US
Telephone Number	:	616-805-6882
Fax Number	:

Provider Business Practice Location Address
First Line	:	4910 60TH ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49512
Country	:	US
Telephone Number	:	616-805-6882
Fax Number	:

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT - OPERATIONS
Name	:	KATHRYN GARRY
Credential	:
Telephone Number	:	248-719-0388

Provider Enumeration Date	:	12/17/2025
Last Update Date	:	12/17/2025

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