Provider Demographics
NPI:1184608820
Name:SPECTRUM HEALTH WORTH SERVICES
Entity type:Organization
Organization Name:SPECTRUM HEALTH WORTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:
Authorized Official - Phone:616-486-2405
Mailing Address - Street 1:750 FULLER AVENUE NE MC 160
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-643-9083
Mailing Address - Fax:616-643-9060
Practice Address - Street 1:4500 BRETON ROAD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508
Practice Address - Country:US
Practice Address - Phone:616-391-5722
Practice Address - Fax:616-391-5721
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPECTRUM HEALTH CONTINUING CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-06
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility