NPIMap

Organization Active NPI

Spectrum Health Kent Community Campus

Doing business as Spectrum Health Rehab & Nursing Center Fuller

  • Skilled Nursing Facility
  • Grand Rapids, MI
National Provider Identifier
1740264522
Registry record updated Mar 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
413090 Issued in MI
Legal business name
SPECTRUM HEALTH KENT COMMUNITY CAMPUS
Doing business as
Spectrum Health Rehab & Nursing Center Fuller
Practice address
750 Fuller Ave NE
Grand Rapids, MI 49503-1918
Phone
(616) 391-4200
Fax
(616) 486-2419
NPI assigned
Dec 5, 2005
Last updated
Mar 26, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2015

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

Authorized official

Name
Kevin Smith
Title
VP Finance
Phone
(616) 486-2672

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 413090 MI
Skilled Nursing Facility 314000000X 413090 MI Primary

Addresses

Primary practice location

750 Fuller Ave NE
Grand Rapids, MI 49503-1918

Mailing address

750 Fuller Ave NE
Grand Rapids, MI 49503-1918
Phone (616) 391-4200

Other identifiers 2

IdentifierTypeStateIssuer
09978OtherMIBCBS
624151184MedicaidMI

Other names 1

  • Spectrum Health Rehab & Nursing Center Fuller Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427328000000",
    "number": "1740264522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 FULLER AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031918",
            "telephone_number": "616-391-4200",
            "fax_number": "616-643-9060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 FULLER AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031918",
            "telephone_number": "616-391-4200",
            "fax_number": "616-486-2419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEALTH KENT COMMUNITY CAMPUS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-05",
        "last_updated": "2015-03-26",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "616-486-2672"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "MI",
            "license": "413090",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "413090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "09978",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "624151184",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spectrum Health Rehab & Nursing Center Fuller",
            "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 Mar 26, 2015; 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.