| Pine Rest Christian Mental Health Services | |
|
300 68th Street Se Grand Rapids MI 49548 | |
| (616) 281-6372 | |
| Not Available |
| Full Name | Pine Rest Christian Mental Health Services |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 300 68th Street Se, Grand Rapids, Michigan |
| Authorized Official Name and Position | Diane Fennema (MANAGED CARE ADMINISTRATOR) |
| 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) 281-6372 | Pine Rest Christian Mental Health Services 300 68th Street Se Grand Rapids MI 49548 Ph: (616) 281-6372 |
| NPI Number | 1841791357 |
|---|---|
| Provider Enumeration Date | 02/21/2018 |
| Last Update Date | 11/04/2020 |
| Certification Date | 11/04/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841791357 | NPI | - | NPPES |
| SA0410417 | Other | MI | BC/BS SUBSTANCE ABUSE - CAMPUS CLINIC 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | SA0410417 (Michigan) | Primary |
| 324500000X | Substance Abuse Rehabilitation Facility | SA0410417 (Michigan) | Secondary |
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