# GERONTOLOGY NETWORK

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598955510
- **Authorized official:** THOMAS A HARTWIG PHD (PRESIDENT CEO)
- **Authorized official phone:** (616) 456-6135

## Contact information

- **Practice address:** 516 CHERRY ST SE, GRAND RAPIDS, MI 49503-4702
- **Practice address phone:** (616) 456-6135
- **Practice address fax:** (616) 771-9771
- **Mailing address:** 500 CHERRY ST SE, GRAND RAPIDS, MI 49503-4702
- **Mailing address phone:** (616) 456-6135
- **Mailing address fax:** (616) 771-9771

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | NULL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |
| 101YM0800X | Mental Health Counselor | — | NULL | — |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 1041C0700X | Clinical Social Worker | — | NULL | — |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 2084P0805X | Geriatric Psychiatry Physician | — | NULL | — |
| 2084P0805X | Geriatric Psychiatry Physician | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |

## Other

- **Enumeration date:** 07/26/2007
- **Last updated:** 07/26/2007