Provider Demographics
NPI:1437226545
Name:REHABILITATION RESTORATION RELAZATION STATION INC.
Entity Type:Organization
Organization Name:REHABILITATION RESTORATION RELAZATION STATION INC.
Other - Org Name:R3 STATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:BSOTR
Authorized Official - Phone:616-475-7830
Mailing Address - Street 1:1152 BURTON ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3359
Mailing Address - Country:US
Mailing Address - Phone:616-475-7830
Mailing Address - Fax:
Practice Address - Street 1:1152 BURTON ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3359
Practice Address - Country:US
Practice Address - Phone:616-475-7830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932281565OtherNPI
MI1932281565OtherNPI