Provider Demographics
NPI:1427444595
Name:SPECTRUM HEALTH CONTINUING CARE
Entity type:Organization
Organization Name:SPECTRUM HEALTH CONTINUING CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-486-6790
Mailing Address - Street 1:100 MICHIGAN ST NE MC 845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1918
Mailing Address - Country:US
Mailing Address - Phone:616-486-2404
Mailing Address - Fax:
Practice Address - Street 1:1 STATE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337
Practice Address - Country:US
Practice Address - Phone:231-355-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
237213Medicare Oscar/Certification