Eastern Grouphome

Primary specialty

PACE Provider OrganizationTaxonomy code 251T00000X

Legal business name

EASTERN GROUPHOME

Practice address

5770 Eastern Ave SE
Grand Rapids, MI 49508-6281

Phone

(616) 516-3888

NPI assigned

Jan 17, 2018

Last updated

Jan 17, 2018By 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

Amanuel Asfaha

Title

Owener

Phone

(616) 516-3888

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1516147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516147200000",
    "number": "1639687213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5770 EASTERN AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495086281",
            "telephone_number": "616-516-3888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5770 EASTERN AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495086281",
            "telephone_number": "616-516-3888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN GROUPHOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-17",
        "last_updated": "2018-01-17",
        "status": "A",
        "authorized_official_last_name": "ASFAHA",
        "authorized_official_first_name": "AMANUEL",
        "authorized_official_title_or_position": "OWENER",
        "authorized_official_telephone_number": "616-516-3888"
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Bethany G Eastman, PA-C

• PACE Provider Organization in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• PACE Provider Organization in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2018; 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.