| Organization Name: | PINE REST CHRISTIAN MENTAL HEALTH SERVICES |
| NPI Number: | 1467873414 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK EASTBURG (CEO, PRESIDENT) |
| Mailing Address: | 300 68th St Se Grand Rapids |
| State: | MI US |
| Postal Code: | 495486927 |
| Phone Number: | 6164555000 |
| Fax Number: | |
| NPI Enumeration Date: | 12/18/2013 |
| NPI Last Update Date: | 12/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |