NPIMap

Organization Active NPI

Christian Rest Home Association

  • Assisted Living Facility
  • Grand Rapids, MI
National Provider Identifier
1720350341
Registry record updated Jan 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AH410236778 Issued in MI
Legal business name
CHRISTIAN REST HOME ASSOCIATION
Doing business as
EDISON ASSISTED LIVING CENTER
Practice address
1010 Edison Ave NW
Grand Rapids, MI 49504-3918
Phone
(616) 453-0581
Fax
(616) 791-0910
NPI assigned
Jan 27, 2012
Organization subpart
Yes
Parent organization
CHRISTIAN REST HOME ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 27, 2012

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

Authorized official

Name
James Horjus
Title
Administrator
Phone
(616) 453-0581

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AH410236778 MI Primary

Addresses

Primary practice location

1010 Edison Ave NW
Grand Rapids, MI 49504-3918

Mailing address

1010 Edison Ave NW
Grand Rapids, MI 49504-3918
Phone (616) 453-0581

Other identifiers 1

IdentifierTypeStateIssuer
AH410236778OtherMIMICHIGAN DEPARTMENT OF HUMAN SERVICES

Other names 1

  • EDISON ASSISTED LIVING CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Christian Rest Home2 organizations share this tax ID, including this one
Part of
Christian Rest Home

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1327622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327622400000",
    "number": "1720350341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 EDISON AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495043918",
            "telephone_number": "616-453-0581",
            "fax_number": "616-791-0910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 EDISON AVE NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495043918",
            "telephone_number": "616-453-0581",
            "fax_number": "616-791-0910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTIAN REST HOME ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHRISTIAN REST HOME ASSOCIATION",
        "enumeration_date": "2012-01-27",
        "last_updated": "2012-01-27",
        "status": "A",
        "authorized_official_last_name": "HORJUS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "616-453-0581"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MI",
            "license": "AH410236778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MICHIGAN DEPARTMENT OF HUMAN SERVICES",
            "identifier": "AH410236778",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EDISON ASSISTED LIVING CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 27, 2012; 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.