Provider Demographics
NPI:1164734364
Name:SPECTRUM HEALTH WORTH SERVICES
Entity Type:Organization
Organization Name:SPECTRUM HEALTH WORTH SERVICES
Other - Org Name:SPECTRUM HEALTH NEURO REHAB SERVICES-RESIDENTIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SHCC/DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:OBERST
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:616-486-2405
Mailing Address - Street 1:750 FULLER AVE NE
Mailing Address - Street 2:MAIL CODE 133
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1918
Mailing Address - Country:US
Mailing Address - Phone:616-455-7300
Mailing Address - Fax:
Practice Address - Street 1:4130 KALAMAZOO AVE SE
Practice Address - Street 2:MAIL CODE 017
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-3605
Practice Address - Country:US
Practice Address - Phone:616-455-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECTRUM HEALHT CONTINUING CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities