1548345879 NPI number — THE GRAND RIVER HEALTH SYSTEMS CORP.

Table of content: (NPI 1548345879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548345879 NPI number — THE GRAND RIVER HEALTH SYSTEMS CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE GRAND RIVER HEALTH SYSTEMS CORP.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548345879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 11TH ST
Provider Second Line Business Mailing Address:
SUITE 14
Provider Business Mailing Address City Name:
CHILLICOTHEE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64601-1676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-646-2682
Provider Business Mailing Address Fax Number:
660-646-2688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 11TH ST
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
CHILLICOTHEE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64601-1554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-646-2682
Provider Business Practice Location Address Fax Number:
660-646-2688
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MINNIS
Authorized Official First Name:
HOLLY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
660-646-2682

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  107238 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207R00000X , with the licence number: 106544 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363A00000X , with the licence number: 2002012315 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com