Provider Demographics
NPI:1508845066
Name:PORTER HILLS HOME HEALTH WEST
Entity Type:Organization
Organization Name:PORTER HILLS HOME HEALTH WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF QUALITY AND COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTHE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:616-719-4161
Mailing Address - Street 1:3600 FULTON ST E
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-1322
Mailing Address - Country:US
Mailing Address - Phone:616-949-5140
Mailing Address - Fax:616-575-5123
Practice Address - Street 1:3600 FULTON ST E
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-1322
Practice Address - Country:US
Practice Address - Phone:616-949-5140
Practice Address - Fax:616-575-5123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3480544Medicaid
MI0E159OtherBLUE CROSS BLUE SHIELD
MI3480544Medicaid