| Family Outreach Center | |
|
1939 S Division Grand Rapids MI 49507 | |
| (616) 247-3815 | |
| (616) 245-0450 |
| Full Name | Family Outreach Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1939 S Division, Grand Rapids, Michigan |
| Authorized Official Name and Position | Veneese Chandler (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6162473815 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Outreach Center 1939 S Division Grand Rapids MI 49507 Ph: (616) 247-3815 | Family Outreach Center 1939 S Division Grand Rapids MI 49507 Ph: (616) 247-3815 |
| NPI Number | 1619980927 |
|---|---|
| Provider Enumeration Date | 08/15/2006 |
| Last Update Date | 03/08/2018 |
| Medicare PECOS PAC ID | 0446144331 |
|---|---|
| Medicare Enrollment ID | O20040211000799 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619980927 | NPI | - | NPPES |
| 0D16322 | Other | MI | MEDICARE ID |
| 4483587 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Rebecca J Stevens |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1427295773 PECOS PAC ID: 0547310146 Enrollment ID: I20090602000273 |
| Provider Name | Dolores H Sneed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871752972 PECOS PAC ID: 0840447751 Enrollment ID: I20120829000104 |
| Provider Name | Nebojsa Malbasa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1497275259 PECOS PAC ID: 8325454598 Enrollment ID: I20210312001610 |
| Provider Name | Caitlin Quantock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558968982 PECOS PAC ID: 3870952799 Enrollment ID: I20230710002055 |
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