Provider Demographics
NPI:1588974620
Name:CHG-COMPHEALTH
Entity type:Organization
Organization Name:CHG-COMPHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:WINEHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-453-3030
Mailing Address - Street 1:PO BOX 713100
Mailing Address - Street 2:
Mailing Address - City:SALT LK. CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171-3100
Mailing Address - Country:US
Mailing Address - Phone:800-453-3030
Mailing Address - Fax:
Practice Address - Street 1:2900 CHARLEVOIX DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7085
Practice Address - Country:US
Practice Address - Phone:800-453-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC002370L273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit