Provider Demographics
NPI:1730133463
Name:MARY FREE BED REHABILITATION HOSPITAL
Entity Type:Organization
Organization Name:MARY FREE BED REHABILITATION HOSPITAL
Other - Org Name:MARY FREE BED REHABILITATION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PODVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-840-8676
Mailing Address - Street 1:235 WEALTHY SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5299
Mailing Address - Country:US
Mailing Address - Phone:616-840-8676
Mailing Address - Fax:
Practice Address - Street 1:235 WEALTHY SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5299
Practice Address - Country:US
Practice Address - Phone:616-242-0403
Practice Address - Fax:616-242-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI410070283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
233026OtherOSCAR
MI101556008Medicaid
3996OtherPRIORITY HEALTH