Provider Demographics
NPI:1689117558
Name:GRAND RIVER HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:GRAND RIVER HOSPITAL DISTRICT
Other - Org Name:GRAND RIVER HEALTH CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-625-1510
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:970-625-6486
Practice Address - Street 1:701 E 5TH ST
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-2909
Practice Address - Country:US
Practice Address - Phone:970-625-1514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO020899385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care