NPIMap

Organization Active NPI

Project Rehab

  • Substance Abuse Rehabilitation Facility
  • Grand Rapids, MI
National Provider Identifier
1104986603
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
410188 Issued in MI
Legal business name
PROJECT REHAB
Practice address
200 Eastern Ave SE
Grand Rapids, MI 49503-4735
Phone
(616) 776-0891
Fax
(616) 776-9906
NPI assigned
Dec 12, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Tommy House, MSW
Title
Executive Direction of Project Reha
Phone
(616) 776-0891

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 410014 MI
Substance Abuse Rehabilitation Facility 324500000X 410163 MI
Substance Abuse Rehabilitation Facility 324500000X 410188 MI Primary

Addresses

Primary practice location

200 Eastern Ave SE
Grand Rapids, MI 49503-4735

Mailing address

330 Eastern Ave SE
Grand Rapids, MI 49503-4737
Phone (616) 776-0891

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104986603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 EASTERN AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034737",
            "telephone_number": "616-776-0891",
            "fax_number": "616-776-9906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 EASTERN AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034735",
            "telephone_number": "616-776-0891",
            "fax_number": "616-776-9906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROJECT REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOUSE",
        "authorized_official_first_name": "TOMMY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTION OF PROJECT REHA",
        "authorized_official_telephone_number": "616-776-0891",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MI",
            "license": "410014",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MI",
            "license": "410163",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "MI",
            "license": "410188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.