# PINE REST CHRISTIAN MENTAL HEALTH SERVICES

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

## Provider details

- **NPI number:** 1841791357
- **Authorized official:** DIANE FENNEMA (MANAGED CARE ADMINISTRATOR)
- **Authorized official phone:** (616) 281-6372

## Contact information

- **Practice address:** 300 68TH STREET SE, GRAND RAPIDS, MI 49548
- **Practice address phone:** (616) 281-6372
- **Mailing address:** 300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
- **Mailing address phone:** (616) 281-6372
- **Mailing address fax:** (616) 281-6459

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | SA0410417 | MI | Yes |
| 324500000X | Substance Abuse Rehabilitation Facility | SA0410417 | MI | — |

## Other

- **Enumeration date:** 02/21/2018
- **Last updated:** 11/04/2020