NPIMap

Organization Active NPI

Porter Hills Home Health West

  • Home Health Agency
  • Grand Rapids, MI
National Provider Identifier
1508845066
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PORTER HILLS HOME HEALTH WEST
Practice address
3600 Fulton St E
Grand Rapids, MI 49546-1322
Phone
(616) 949-5140
Fax
(616) 575-5123
NPI assigned
Jan 12, 2006
Last updated
Oct 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

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

Authorized official

Name
Amy Genthe, PTNPI 1649401035
Title
Director of Quality and Compliance
Phone
(616) 719-4161

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

3600 Fulton St E
Grand Rapids, MI 49546-1322

Mailing address

3600 Fulton St E
Grand Rapids, MI 49546-1322
Phone (616) 949-5140

Other identifiers 2

IdentifierTypeStateIssuer
3480544MedicaidMI
0E159OtherMIBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031103000559 MI Part A Provider - Home Health Agency 0547172009 Practice locations: Chelsea, MI; Grand Rapids, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508845066. Details of each certification follow.

Home health agency certification: CCN 237255

Legal name
PORTER HILLS HOME HEALTH WEST
Doing business as
PORTER HILLS HOME HEALTH CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 16, 1994
Last certification
Feb 14, 2013
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Dec 11, 1997 in MI
Enrollment address
3600 Fulton St E
Grand Rapids, MI 49546-1322

Care Compare: Home health agency

Medicare Care Compare
Listed as
Porter Hills Home Health CareCCN 237255 · All quality measures
Overall star rating
3.5 of 5
Ownership
Non-Profit
Certified
Jun 16, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D1016707Porter Hills Home Health3600 E Fulton Street E, Grand Rapids, MI 49546Certificate of waiverSep 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Porter Hills Retirement Communities Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4450 Cascade Rd SE
Grand Rapids, MI 49546
Phone (616) 949-4975

4450 Cascade Rd SE
#300
Grand Rapids, MI 49546
Phone 616949514020489

555 Cascade West Pkwy SE
Grand Rapids, MI 49546
Phone (616) 949-5140

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Bruce a Lyon Individual Corporate DirectorExecutive Directo, Board Member Mar 1, 2019
W-2 Managing EmployeeExecutive Director Mar 1, 2019
Kimberly Hoppe Individual Corporate OfficerCfo May 1, 2016 50%
Stephen P Fetyko Individual Corporate DirectorCeo Mar 1, 2019
W-2 Managing EmployeeCeo Mar 1, 2019
Nicole Maag Individual Corporate OfficerVP of Opertions - West Home Heal Mar 1, 2019
W-2 Managing EmployeeVP of Operations - West Mar 1, 2019

Practitioners & affiliated clinicians

Practitioners 11

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.

Affiliated clinicians 12

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666051200000",
    "number": "1508845066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 FULTON ST E",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495461322",
            "telephone_number": "616-949-5140",
            "fax_number": "616-575-5123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 FULTON ST E",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495461322",
            "telephone_number": "616-949-5140",
            "fax_number": "616-575-5123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTER HILLS HOME HEALTH WEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-12",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "GENTHE",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "DIRECTOR OF QUALITY AND COMPLIANCE",
        "authorized_official_telephone_number": "616-719-4161",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3480544",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0E159",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.