Provider Demographics
NPI:1295098945
Name:IN HOME THERAPY OF GRAND RAPIDS, LLC
Entity type:Organization
Organization Name:IN HOME THERAPY OF GRAND RAPIDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BATT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:616-799-7891
Mailing Address - Street 1:2433 VALENTINE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-3070
Mailing Address - Country:US
Mailing Address - Phone:616-799-7891
Mailing Address - Fax:616-863-2030
Practice Address - Street 1:2433 VALENTINE BLVD NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-3070
Practice Address - Country:US
Practice Address - Phone:616-799-7891
Practice Address - Fax:616-863-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X, 261QR0400X
MI5501010413261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1295098945Medicaid