Organization
GERONTOLOGY NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS A HARTWIG PHD (PRESIDENT CEO)
(616) 456-6135
Entity
Organization
Contact information
Practice address
800 E BELTLINE AVE NE, GRAND RAPIDS, MI 49525-5848
(616) 456-6135
Mailing address
516 CHERRY ST SE, GRAND RAPIDS, MI 49503-4702
(616) 456-6135
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
—
MI
2084P0800X
Psychiatry Physician
—
MI
2084P0805X
Geriatric Psychiatry Physician
Primary
—
MI
251B00000X
Case Management Agency
—
MI
261QA0600X
Adult Day Care Clinic/Center
—
MI
Other
Enumeration date
02/23/2007
Last updated
05/02/2008
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