Organization
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE FENNEMA (MANAGED CARE ADMINISTRATOR)
(162) 816-3726
Entity
Organization
Contact information
Practice address
2611 WASHINGTON STREET, PELLA, IA 50219
(641) 628-9599
(641) 621-1493
Mailing address
2611 WASHINGTON STREET, PELLA, IA 50219
(641) 628-9599
(641) 621-1493
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0295840
—
IA
Enumeration date
11/07/2006
Last updated
11/04/2020
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