Provider Demographics
NPI:1649218991
Name:GRAND RIVER HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:GRAND RIVER HOSPITAL DISTRICT
Other - Org Name:GRAND RIVER MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:COOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-625-6405
Mailing Address - Street 1:501 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-8510
Mailing Address - Country:US
Mailing Address - Phone:970-625-1510
Mailing Address - Fax:
Practice Address - Street 1:501 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-8510
Practice Address - Country:US
Practice Address - Phone:970-625-1510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO010830282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05042007Medicaid
CO061317Medicare PIN