Organization
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Active
Parent organization
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Organization subpart
Yes
Provider details
NPI number
Legal business name
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Authorized official
DIANE FENNEMA (MANAGED CARE ADMINISTATOR)
(616) 281-6372
Entity
Organization
Contact information
Practice address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
207R00000X
Internal Medicine Physician
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
—
—
283Q00000X
Psychiatric Hospital
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OD11133
BC/BS NURSE PRACTIONER
MI
01
—
OD11275
BC/BS MA, LLP, DOCTORAL
MI
01
—
OD14836
BC/BS PEDIATRICS
MI
01
—
OD14837
BC/BS GNERAL MEDICINE
MI
01
—
OD16083
BC/BS PSYCHIATRY-MULTI SP
MI
01
—
OD16189
BC/BS PSYCHOLOGIST
MI
01
—
OD16222
BC/BS SOCIAL WORKER
MI
01
—
OD17625
BC/BS PSYCHIATRY
MI
Enumeration date
12/12/2007
Last updated
11/04/2020
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