Pine Rest Christian Mental Health Services

NPI #1487665428 in Grand Rapids, Michigan

Provider Information

NPI Number: 1487665428
Entity Type: Organization
Organization Name: Pine Rest Christian Mental Health Services
Subpart: Yes (part of a larger organization)
Parent Organization: PINE REST CHRISTIAN MENTAL HEALTH SERICES
Primary Specialty: Pediatrics
Enumeration Date: Aug 11, 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	Taxonomy Code	Primary
General Practice	208D00000X
Pediatrics	208000000X	Primary

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