Provider Demographics
NPI:1972315802
Name:CHCC GRAND RAPIDS LLC
Entity type:Organization
Organization Name:CHCC GRAND RAPIDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-719-0388
Mailing Address - Street 1:2984 BRADFORD ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6427
Mailing Address - Country:US
Mailing Address - Phone:616-317-8995
Mailing Address - Fax:
Practice Address - Street 1:2984 BRADFORD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6427
Practice Address - Country:US
Practice Address - Phone:616-317-8995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical