Provider Demographics
NPI:1649655564
Name:COGNITIVE AND THERAPEUTIC COMPREHENSIVE HOME HEALTH
Entity type:Organization
Organization Name:COGNITIVE AND THERAPEUTIC COMPREHENSIVE HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ROLAND
Authorized Official - Last Name:FRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-719-9992
Mailing Address - Street 1:800 MONROE AVE NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1445
Mailing Address - Country:US
Mailing Address - Phone:616-421-4800
Mailing Address - Fax:616-499-7083
Practice Address - Street 1:800 MONROE AVE NW
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1445
Practice Address - Country:US
Practice Address - Phone:616-421-4800
Practice Address - Fax:616-499-7083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health