Provider Demographics
NPI:1033137005
Name:AUDRICH, INC.
Entity Type:Organization
Organization Name:AUDRICH, INC.
Other - Org Name:GRAND RAPIDS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TEBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:419-484-1111
Mailing Address - Street 1:670 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9486
Mailing Address - Country:US
Mailing Address - Phone:419-484-1111
Mailing Address - Fax:419-484-4048
Practice Address - Street 1:24201 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:OH
Practice Address - Zip Code:43522-9785
Practice Address - Country:US
Practice Address - Phone:419-832-5195
Practice Address - Fax:419-832-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0274N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4550420002OtherDMERC
OH0966003Medicaid
OH4550420002OtherDMERC