Pine Rest Christian Mental Health Services
NPI #1407866569 in Grand Rapids, Michigan
Provider Information
- NPI Number
- 1407866569
- Entity Type
- Organization
- Organization Name
- Pine Rest Christian Mental Health Services
- Primary Specialty
- Physician Assistant
- Enumeration Date
- Aug 9, 2006
- Last Updated
- Nov 4, 2020
Practice Location
- Address
- 300 68TH ST SE
- City
- Grand Rapids
- State
- Michigan
- ZIP Code
- 49548-6927
- Phone
- (616) 455-5000
Authorized Official
- Name
- DIANE FENNEMA
- Title
- MANAGED CARE ADMINISTRATOR
- Phone
- (616) 281-6372
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physician Assistant |
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