Provider Demographics
NPI:1811209638
Name:SPECTRUM HEALTH WORTH SERVICES
Entity Type:Organization
Organization Name:SPECTRUM HEALTH WORTH SERVICES
Other - Org Name:SPECTRUM HEALTH NEURO REHAB SERVICES-REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SHCC/DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:OBERST
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:616-486-2405
Mailing Address - Street 1:4500 BRETON RD SE
Mailing Address - Street 2:SAMIL CODE 159
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5290
Mailing Address - Country:US
Mailing Address - Phone:616-391-5732
Mailing Address - Fax:616-391-5731
Practice Address - Street 1:4500 BRETON RD SE
Practice Address - Street 2:SAMIL CODE 159
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-5290
Practice Address - Country:US
Practice Address - Phone:616-391-5732
Practice Address - Fax:616-391-5731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty