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Organization
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Active
Organization
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE FENNEMA (MANAGED CARE ADMINISTRATOR)
(616) 281-6372
Entity
Organization
Contact information
Practice address
300 68TH STREET SE, GRAND RAPIDS, MI 49548
(616) 281-6372
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 281-6372
(616) 281-6459
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
SA0410417
MI
324500000X
Substance Abuse Rehabilitation Facility
SA0410417
MI
Other
Enumeration date
02/21/2018
Last updated
11/04/2020
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