Pine Rest Christian Mental Health Services
Psychiatry Physician in Grand Rapids, MI(View on Map)
Legal Business Name
Pine Rest Christian Mental Health Services
NPI Number
1174532147
NPI Type
Organization
Enumeration Date
08/07/2006
Specialties
(Taxonomies)Name
Code
2084P0800X
101Y00000X
208D00000X
207R00000X
208000000X
103T00000X
104100000X
Primary Taxonomy
Yes
No
No
No
No
No
No
Contact
Information
Purpose
Mailing
Location
Address
300 68TH ST SE
300 68TH ST SE
City
Grand Rapids
Grand Rapids
State
MI
MI
Postal Code
49548-6927
49548-6927
Country
US
US
Telephone Number
(616) 455-5000
(616) 455-5000
Authorized Official
Name
Diane Fennema
Title or Position
VP OF GENERAL SERVICES
Telephone Number
(616) 281-6372
Identifiers
Identifier
350D148360
P10D11275
260D17625
680D16189
70D16083
110D148370
500D11133
Identifier State
MI
MI
MI
MI
MI
MI
MI
Identifier Issuer
PEDIATRICS
PSYCHOLOGISTS-MA, DOCTORA
PSYCHIATRISTS
PSYCHOLOGISTS
MULTISPECIALTY
INTERNAL MD
NURSE PRACTICIONERS
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 11/04/2020
Provider Address
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