| Pine Rest Christian Mental Health Services | |
|
300 68th St Se Grand Rapids MI 49548-6927 | |
| (616) 455-5000 | |
| Not Available |
| Full Name | Pine Rest Christian Mental Health Services |
|---|---|
| Speciality | Pediatrics |
| Location | 300 68th St Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Diane Fennema (MANAGED CARE ADMINISTATOR) |
| Authorized Official Contact | 6162816372 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pine Rest Christian Mental Health Services 300 68th St Se Grand Rapids MI 49548-6927 Ph: (616) 455-5000 | Pine Rest Christian Mental Health Services 300 68th St Se Grand Rapids MI 49548-6927 Ph: (616) 455-5000 |
| NPI Number | 1487837506 |
|---|---|
| Provider Enumeration Date | 12/12/2007 |
| Last Update Date | 11/04/2020 |
| Certification Date | 11/04/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487837506 | NPI | - | NPPES |
| OD16083 | Other | MI | BC/BS PSYCHIATRY-MULTI SP |
| OD16222 | Other | MI | BC/BS SOCIAL WORKER |
| OD14837 | Other | MI | BC/BS GNERAL MEDICINE |
| OD17625 | Other | MI | BC/BS PSYCHIATRY |
| OD16189 | Other | MI | BC/BS PSYCHOLOGIST |
| OD11275 | Other | MI | BC/BS MA, LLP, DOCTORAL |
| OD11133 | Other | MI | BC/BS NURSE PRACTIONER |
| OD14836 | Other | MI | BC/BS PEDIATRICS |
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