CMS-1500 Box 24J / 33a • NPI
1881102788
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
1041C0700X (CMS 80)
Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical
Box 32 Service Location & ZIP+4
3212 EASTERN AVE SE, GRAND RAPIDS, MI, 49508
Official NPPES Practice Location
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1881102788 (A GRAND RAPIDS SENIOR SOCIAL EXCHANGE AND ADULT DAY CENTER) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1881102788 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | A GRAND RAPIDS SENIOR SOCIAL EXCHANGE AND ADULT DAY CENTER |
| Plain-English Specialty | Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical NUCC Code: 1041C0700X (Social Worker, Clinical) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 3212 EASTERN AVE SE, GRAND RAPIDS, MI, 49508 |
| Practice Telephone / Fax | Tel: (616) 329-4101 |
| Administrative Mailing Address | PO BOX 7004, GRAND RAPIDS, MI, 49510-7004 |
| Enumeration & Last Sync | Enumerated: 2018-01-14 | CMS Record Updated: 2018-07-02 |
| Authorized Official | JODIE ROBERTSON (owner) |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (1041C0700X)
What Does Taxonomy Code 1041C0700X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1041C0700X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (A GRAND RAPIDS SENIOR SOCIAL EXCHANGE AND ADULT DAY CENTER)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
253Z00000X — In Home Supportive CarePlain English: Licensed & Credentialed In Home Supportive Care | State: N/A | License: Verified | Primary: Secondary |
385H00000X — Respite CarePlain English: Licensed & Credentialed Respite Care | State: N/A | License: Verified | Primary: Secondary |
1041C0700X — Social Worker, ClinicalPlain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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