Provider Demographics
NPI:1912076142
Name:PORTER HILLS REHABILITATION, L.L.C.
Entity Type:Organization
Organization Name:PORTER HILLS REHABILITATION, L.L.C.
Other - Org Name:PORTER HILLS REHABILITATION, L.L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REHAB MANAGER, CORF ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHAPIE
Authorized Official - Suffix:
Authorized Official - Credentials:MSA, OTR
Authorized Official - Phone:616-942-5965
Mailing Address - Street 1:3600 FULTON ST E
Mailing Address - Street 2:STE. R
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-1322
Mailing Address - Country:US
Mailing Address - Phone:616-942-5975
Mailing Address - Fax:616-974-1983
Practice Address - Street 1:3600 FULTON ST E
Practice Address - Street 2:STE. R
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-1322
Practice Address - Country:US
Practice Address - Phone:616-942-5975
Practice Address - Fax:616-974-1983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORTER HILLS PRESBYTERIAN VILLIAGE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-06
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI234522Medicare Oscar/Certification