Organization
FAMILY OUTREACH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VENEESE CHANDLER (EXECUTIVE DIRECTOR)
(616) 247-3815
Entity
Organization
Contact information
Practice address
1939 S DIVISION, GRAND RAPIDS, MI 49507
(616) 247-3815
(616) 245-0450
Mailing address
1939 S DIVISION, GRAND RAPIDS, MI 49507
(616) 247-3815
(616) 245-0450
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D16322
MEDICARE ID
MI
05
—
4483587
—
MI
Enumeration date
08/15/2006
Last updated
03/08/2018
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