MR. MARK FREDERIC PETERSON NPI 1841474012

NPI Information

  • NPI: 1841474012
  • Provider Name: MR. MARK FREDERIC PETERSON
  • Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
  • Entity Type: Individual
  • Address: 3351 36TH ST
    GRAND RAPIDS, MI
    ZIP 49331
  • Phone: (616) 831-5659

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NPI Details

MR. Mark Frederic Peterson is a community based residential treatment facility, intellectual and/or developmental disabilities in Grand Rapids, MI. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. MR. Mark Frederic Peterson NPI is 1841474012. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3351 36TH ST
GRAND RAPIDS, MI
ZIP 49331
Phone: (616) 831-5659

The enumeration date for this NPI number is 12/24/2007 and was last updated on 12/24/2007.

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
1320900000XCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities6802071051MICHIGANYes

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: 3/30/2025

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