Provider Demographics
NPI:1093585374
Name:INSTITUTE OF CONTEXTUAL HUMAN HEALTH, WELLNESS, AND PERFORMANCE
Entity Type:Organization
Organization Name:INSTITUTE OF CONTEXTUAL HUMAN HEALTH, WELLNESS, AND PERFORMANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:FALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-928-4626
Mailing Address - Street 1:5429 NORTHLAND DR NE STE A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1089
Mailing Address - Country:US
Mailing Address - Phone:616-855-0540
Mailing Address - Fax:
Practice Address - Street 1:5429 NORTHLAND DR NE STE A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1089
Practice Address - Country:US
Practice Address - Phone:616-855-0540
Practice Address - Fax:616-855-1185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty