Great Lakes Specialty Hospital - Oak LLC

Primary specialty

Long Term Care HospitalTaxonomy code 282E00000X

License

610052 Issued in MI

Legal business name

GREAT LAKES SPECIALTY HOSPITAL - OAK LLC

Doing business as

Select Specialty Hospital - Grand Rapids

Practice address

200 Jefferson Ave SE
5TH Floor
Grand Rapids, MI 49503-4502

Phone

(231) 777-6202

Fax

(231) 777-6207

NPI assigned

Jul 10, 2006

Last updated

Sep 28, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael Tarvin

Title

Vice President

Phone

(717) 972-1100

Specialties & licenses 1

Addresses

Other names 1

• Select Specialty Hospital - Grand Rapids Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609800614. Details of each certification follow.

• CCN 232026 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 232026

Legal name

SELECT SPECIALTY HOSPITAL - GRAND RAPIDS

Certification status

Terminated Voluntary: merger or closure, Aug 3, 2017

Provider type (POS)

Hospital – Long-term

Participating since

Jan 1, 2000

Last certification

Jun 17, 1999

Beds

20

Ownership / control type

Private (for profit)

Most recent change of ownership

Sep 1, 2009 (1 total)

Facility address

200 SE Jefferson, 5TH Floor
Grand Rapids, MI 49503

Locations

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443398400000",
    "number": "1609800614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4714 GETTYSBURG RD",
            "address_2": "LEGAL DEPT",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170554325",
            "telephone_number": "717-972-1100",
            "fax_number": "717-975-9981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 JEFFERSON AVE SE",
            "address_2": "5TH FLOOR",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034502",
            "telephone_number": "231-777-6202",
            "fax_number": "231-777-6207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES SPECIALTY HOSPITAL - OAK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2015-09-28",
        "status": "A",
        "authorized_official_last_name": "TARVIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "717-972-1100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "MI",
            "license": "610052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Select Specialty Hospital - Grand Rapids",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Long Term Care Hospital in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Long Term Care Hospital in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.