Provider Demographics
NPI:1053641589
Name:MARY FREE BED REHABILITATION HOSPITAL
Entity Type:Organization
Organization Name:MARY FREE BED REHABILITATION HOSPITAL
Other - Org Name:MARY FREE BED MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PODVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-840-8317
Mailing Address - Street 1:235 WEALTHY ST SE
Mailing Address - Street 2:STE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5247
Mailing Address - Country:US
Mailing Address - Phone:616-840-8000
Mailing Address - Fax:616-840-9640
Practice Address - Street 1:235 WEALTHY ST SE
Practice Address - Street 2:STE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5247
Practice Address - Country:US
Practice Address - Phone:616-840-8000
Practice Address - Fax:616-840-9640
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARY FREE BED HOSPITAL AND REHABILITATION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-06
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty