Organization
BETHANY CHRISTIAN SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER POTHOOF (BILLING)
(616) 224-7617
Entity
Organization
Contact information
Practice address
901 EASTERN AVE NE, GRAND RAPIDS, MI 49503-1201
(616) 224-7617
Mailing address
901 EASTERN AVE. SE, PO BOX 294, GRAND RAPIDS, MI 49503
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801093691
MI
Other
Enumeration date
11/03/2011
Last updated
11/03/2011
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