Pine Rest Christian Mental Health Services

NPI #1487837506 in Grand Rapids, Michigan

Provider Information

NPI Number: 1487837506
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 SERVICES
Primary Specialty: Pediatrics
Enumeration Date: Dec 12, 2007
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 ADMINISTATOR
Phone: (616) 281-6372

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychiatry & Neurology - Addiction Medicine — Addiction Medicine	2084A0401X
Psychiatry & Neurology - Psychiatry — Psychiatry	2084P0800X
Psychiatric Hospital	283Q00000X
Psychologist	103T00000X
Social Worker	104100000X
Internal Medicine	207R00000X
Internal Medicine - Addiction Medicine — Addiction Medicine	207RA0401X
Physician Assistant	363A00000X
Nurse Practitioner	363L00000X
Pediatrics	208000000X	Primary

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