Organization Name: | PINE REST CHRISTIAN MENTAL HEALTH SERVICES |
NPI Number: | 1699786335 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DOUGLAS VANCE (VP OF GENERAL SERVICES) |
Mailing Address: | 300 68th St Se Grand Rapids |
State: | MI US |
Postal Code: | 495486927 |
Phone Number: | 6164555000 |
Fax Number: | |
NPI Enumeration Date: | 08/10/2006 |
NPI Last Update Date: | 07/18/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |