PINE REST CHRISTIAN MENTAL HEALTH SERVICES (NPI# 1124171954) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124171954 |
| Entity Type | Organization |
| Organization Name | PINE REST CHRISTIAN MENTAL HEALTH SERVICES |
| Practice Address |
1050 Silver Dr Traverse City MI 49684-5749 |
| Mailing Address |
300 68th St Se Grand Rapids MI 49548-6927 |
| Practice Telephone | 2319472255 |
| Mailing Telephone | 6164555000 |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-11-04 |
| Authorized Official Name | DIANE FENNEMA (MANAGED CARE ADMINISTATOR) |
| Authorized Official Telephone | 6162816372 |
| Is Organization Subpart | Y |
| Parent Organization Name | PINE REST CHRISTIAN MENTAL HEALTH SERVICES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 101Y00000X | Counselor | Behavioral Health & Social Service Providers | ||
| N | 103G00000X | Clinical Neuropsychologist | Behavioral Health & Social Service Providers | ||
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| N | 104100000X | Social Worker | Behavioral Health & Social Service Providers | ||
| N | 1041S0200X |
Social Worker Specialization: School |
Behavioral Health & Social Service Providers | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 283Q00000X | Psychiatric Hospital | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | INTERNAL MEDICINE | 110D148370 | 01 |
| MI | PSYCHOLOGISTS-DOCTORAL LL | P10D11275 | 01 |
| MI | PSYCHOLOGISTS | 680D16189 | 01 |
| MI | BCBS PSYCHIATRIST | 260D17625 | 01 |
| MI | NURSE PRACTIONERS | 500D11133 | 01 |
| MI | MULTISPECIALTY | PSYCHIATIRSTS | 01 |
| MI | PEDIATRICS | 350D148360 | 01 |
| MI | SOCIAL WORKERS | 800D16222 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154339521 | Pine Rest Christian Mental Health Services | Psychologist | 550 - 3 Mile Rd Nw, Grand Rapids, MI 49544-1673 | 2006-08-03 |
| 1841791357 | Pine Rest Christian Mental Health Services | Substance Abuse Rehabilitation Facility | 300 68th Street Se, Grand Rapids, MI 49548 | 2018-02-21 |
| 1952818551 | Pine Rest Christian Mental Health Services | Substance Abuse Rehabilitation Facility | 450 Meadow Run Dr, Hastings, MI 49058-9053 | 2018-01-04 |
| 1619341310 | Pine Rest Christian Mental Health Services | Counselor | 9090 S Rodgers Ct Se, Caledonia, MI 49316-8052 | 2015-11-18 |
| 1598138810 | Pine Rest Christian Mental Health Services | Counselor | 1870 Leonard St Ne, Grand Rapids, MI 49505-5650 | 2015-11-09 |
| 1386015683 | Pine Rest Christian Mental Health Services | Counselor | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2015-10-13 |
| 1467840553 | Pine Rest Christian Mental Health Services | Nurse Practitioner | 17325 Van Wagoner Rd, Spring Lake, MI 49456-9702 | 2014-12-26 |
| 1821414566 | Pine Rest Christian Mental Health Services | Counselor | 1350 W Centre Ave, Portage, MI 49024-5361 | 2014-03-05 |
| 1467873414 | Pine Rest Christian Mental Health Services | Speech-Language Pathologist | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2013-12-18 |
| 1427216241 | Pine Rest Christian Mental Health Services | Counselor | 4294 Laurel Dr, Lake Odessa, MI 48849-9423 | 2008-05-29 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | 300 68th St Se, Grand Rapids, MI 49548-6927 |
| Iowa Business Entities | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | 300 68th St Se, Grand Rapids, MI 49548 |
| Street Address |
1050 SILVER DR |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49684-5749 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124095971 | Brian Albert Ameel | Psychiatry & Neurology | 1050 Silver Dr, Traverse City, MI 49684-5749 | 2006-03-01 |
| 1841800067 | Janelle Marie Youngdahl | Psychologist | 1050 Silver Dr, Traverse City, MI 49684-5749 | 2020-08-03 |
| 1760033070 | Gregory Schroeder | Social Worker | 1050 Silver Dr, Traverse City, MI 49684-5749 | 2019-09-27 |
| 1235695651 | Faith Jessica Huyck | Nurse Practitioner | 1050 Silver Dr, Traverse City, MI 49684-5749 | 2019-02-11 |
| 1760910624 | Jenna Lang | Social Worker | 1050 Silver Dr, Traverse City, MI 49684-5749 | 2017-05-23 |
| 1437527769 | Jennifer Kraus | Social Worker | 1050 Silver Dr, Traverse City, MI 49684-5749 | 2015-09-03 |
| 1982072245 | Paula Ann Kilcherman | Social Worker | 1050 Silver Dr, Traverse City, MI 49684-5749 | 2015-09-03 |
| 1164821245 | Melanie Villanueva | Social Worker | 1050 Silver Dr, Traverse City, MI 49684-5749 | 2014-08-14 |
| 1962826982 | Susan Kirt | Social Worker | 1050 Silver Dr, Traverse City, MI 49684-5749 | 2014-02-11 |
| 1134558463 | Kristine Elizabeth Wilmoth | Psychologist | 1050 Silver Dr, Traverse City, MI 49684-5749 | 2013-11-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124641758 | Karen Anne Paulosky | Registered Nurse | 226 S Madison St, Traverse City, MI 49684 | 2020-05-18 |
| 1891314795 | Jaclyn Elizabeth Sylvain | Student in an Organized Health Care Education/Training Program | Munson Family Practice Center, 1400 Medical Campus Drive, Traverse City, MI 49684 | 2020-04-10 |
| 1285282988 | Madelyn Drumm | Dietitian, Registered | 217 S. Madison St., Suite 3022, Traverse City, MI 49684 | 2019-08-27 |
| 1265917686 | Kacie Danielle Heading | Social Worker | 12719 S. West Bay Shore Drive, Suite 9, Traverse City, MI 49684 | 2018-10-02 |
| 1881178325 | Jacob White Ph.d., Pllc | Psychologist | 3537 W. Front Street, Suite F, Traverse City, MI 49684 | 2018-09-20 |
| 1144702572 | Constance Baab, Phd, Lmsw, Pllc | Social Worker | 3301 Veterans Drive Suite 127, Traverse City, MI 49684 | 2018-09-01 |
| 1346732880 | The Skin Cancer and Dermatology Center Plc | Dermatology | 1225 W Front St Ste 2, Traverse City, MI 49684 | 2018-05-31 |
| 1790283851 | Lisa Louise Kleyps | Massage Therapist | 3337 W. South Airport Road #2, Traverse City, MI 49684 | 2018-01-24 |
| 1114447646 | Brittany Alexandra Prior | Physical Therapist | 3899 W Front Sreet, Unit 3, Traverse City, MI 49684 | 2017-06-26 |
| 1568902963 | Jennifer Scott | Behavior Technician | 515 W 14th St Unit D, Traverse City, MI 49684 | 2017-03-03 |
| Find all providers in zip 49684 | ||||
| Taxonomy Code | 283Q00000X |
| Grouping | Hospitals |
| Classification | Psychiatric Hospital |
| An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings. |
| Notes: Source: Expanded from Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285277814 | Lansing Senior Partners LLC | Psychiatric Hospital | 3512 Coolidge Rd, East Lansing, MI 48823-6376 | 2019-10-27 |
| 1336498013 | Genesys Hillside Behavioral Services | Psychiatric Hospital | 4396 Meadows Ave, Grand Blanc, MI 48439-8689 | 2012-09-10 |
| 1275727653 | Head To Mind Psychiatric Services Inc | Psychiatric Hospital | 19450 Argyle Cres, Detroit, MI 48203-1402 | 2007-08-29 |
| 1629108766 | Circle of Life | Psychiatric Hospital | 24080 Seneca St, Oak Park, MI 48237-3725 | 2007-03-07 |
| 1205973922 | Circle of Life Psychiatric Hospital | Psychiatric Hospital | 403 Village Green Blvd, Apt 106, Ann Arbor, MI 48105-3612 | 2007-01-31 |
| 1588672406 | T & G Corporation Inc | Psychiatric Hospital | 4050 E 12 Mile Rd, Warren, MI 48092-2534 | 2006-08-04 |
| 1053342220 | Havenwyck Hospital Inc | Psychiatric Hospital | 1525 University Dr, Auburn Hills, MI 48326-2673 | 2006-07-06 |
| 1710918362 | Henry Ford Health System | Psychiatric Hospital | 10300 W 8 Mile Rd, Ferndale, MI 48220-2100 | 2006-07-05 |
| 1033108832 | Triangle Industries Inc | Psychiatric Hospital | 15000 Gratiot Ave, Detroit, MI 48205-1973 | 2005-10-14 |
| 1053841650 | Havenwyck Hospital Inc | Psychiatric Hospital | 101 W Townsend Rd, St Johns, MI 48879 | 2017-06-15 |
| Find all providers with the same taxonomy | ||||
| City | TRAVERSE CITY |
| Zip Code | 49684 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.