# PINE REST CHRISTIAN MENTAL HEALTH SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PINE REST CHRISTIAN MENTAL HEATLH SERVICES
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1467463604
- **Legal business name:** PINE REST CHRISTIAN MENTAL HEATLH SERVICES
- **Authorized official:** DIANE FENNEMA (MANAGED CARE ADMINISTRATOR)
- **Authorized official phone:** (616) 281-6372

## Contact information

- **Practice address:** 300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
- **Practice address phone:** (616) 455-5000
- **Mailing address:** 300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
- **Mailing address phone:** (616) 455-5000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/11/2006
- **Last updated:** 11/04/2020