Provider Demographics
NPI:1427283480
Name:WEST BROOK RECOVERY CENTER LLC
Entity type:Organization
Organization Name:WEST BROOK RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:KAE
Authorized Official - Last Name:ROSENZWEIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-957-1200
Mailing Address - Street 1:3210 EAGLE RUN DR NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7051
Mailing Address - Country:US
Mailing Address - Phone:616-957-1200
Mailing Address - Fax:616-957-1297
Practice Address - Street 1:3210 EAGLE RUN DR NE
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7051
Practice Address - Country:US
Practice Address - Phone:616-957-1200
Practice Address - Fax:616-957-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility