PINE REST CHRISTIAN MENTAL HEALTH SERVICES NPI 1679777049

NPI Information

NPI: 1679777049
Provider Name: PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Classification: Internal Medicine - 207RA0401X
Entity Type: Organization

Specialization: Addiction Medicine

Address:
243 68TH ST SE
GRAND RAPIDS, MI
ZIP 49548
Phone: (616) 281-6836
Get Directions

PINE REST CHRISTIAN MENTAL HEALTH SERVICES is an addiction medicine internal medicine in Grand Rapids, MI. The provider is an internist doctor of osteopathy that specializes in the treatment of addiction disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine can obtain a Certificate of Added Qualifications in the field of Addiction Medicine. PINE REST CHRISTIAN MENTAL HEALTH SERVICES NPI is 1679777049. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

243 68TH ST SE
GRAND RAPIDS, MI
ZIP 49548-924
Phone: (616) 281-6836

The provider's authorized official is Diane Fennema .
The authorized official title is Managed Care Administrator and has the following contact phone number (616) 281-6372.

The enumeration date for this NPI number is 6/12/2007 and was last updated on 11/4/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)			No
2	101YM0800X	Counselor	Mental Health			No
3	103T00000X	Psychologist				No
4	104100000X	Social Worker				No
5	207R00000X	Internal Medicine				No
6	207RA0401X	Internal Medicine	Addiction Medicine			Yes
7	324500000X	Substance Abuse Rehabilitation Facility		410334	MICHIGAN	No
8	363A00000X	Physician Assistant				No
9	363L00000X	Nurse Practitioner				No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	750920290	OTHER	MICHIGAN	BCBS DETOX

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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