PINE REST CHRISTIAN MENTAL HEALTH SERVICES (NPI# 1275544413) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275544413 |
| Entity Type | Organization |
| Organization Name | PINE REST CHRISTIAN MENTAL HEALTH SERVICES |
| Practice Address |
4211 Parkway Place Grandville MI 49418 |
| Mailing Address |
300 68th St Se Grand Rapids MI 49548-6927 |
| Practice Telephone | 6162223700 |
| Mailing Telephone | 6164555000 |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2020-11-04 |
| Authorized Official Name | DIANE FENNEMA (MANAGED CARE ADMINISTRATOR) |
| 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 | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| N | 104100000X | Social Worker | Behavioral Health & Social Service Providers | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | PSYCHOLOGIST | 680D16189 | 01 |
| MI | SOCIAL WORKER | 800D16222 | 01 |
| MI | PSYCHIATRIST | 260D17625 | 01 |
| MI | MA, LLP/DOCTORAL | P10D11275 | 01 |
| MI | NURSE PRACTITIONER | 500D11133 | 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 |
4211 PARKWAY PLACE |
| City | GRANDVILLE |
| State | MI |
| Zip Code | 49418 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487669289 | Leslie Robin Visser | Psychologist | 4211 Parkway Place, Grandville, MI 49418 | 2006-07-30 |
| 1720282668 | Steven James Runner | Psychologist | 4211 Parkway Place, Grandville, MI 49418 | 2007-06-13 |
| 1891813994 | James Robert Grooters | Psychologist | 4211 Parkway Place, Grandville, MI 49418 | 2007-03-27 |
| 1164586095 | Sherry Lynn Norman | Social Worker | 4211 Parkway Place, Grandville, MI 49418 | 2006-12-22 |
| 1770651283 | Kevin Carl Elmore | Psychologist | 4211 Parkway Place, Grandville, MI 49418 | 2006-12-01 |
| 1215026224 | James Patrick Vandenheuvel | Social Worker | 4211 Parkway Place, Grandville, MI 49418 | 2006-10-11 |
| 1144319146 | Gordon John Veeneman | Social Worker | 4211 Parkway Place, Grandville, MI 49418 | 2006-10-11 |
| 1134218142 | James H Vandermay | Social Worker | 4211 Parkway Place, Grandville, MI 49418 | 2006-10-11 |
| 1124114061 | Henry W Bosma | Social Worker | 4211 Parkway Place, Grandville, MI 49418 | 2006-10-05 |
| 1346336104 | Carol J Bosch | Social Worker | 4211 Parkway Place, Grandville, MI 49418 | 2006-10-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144799669 | Holly Cieslinski | Occupational Therapist | 3550 Fairlines Ave, Grandville, MI 49418 | 2018-11-14 |
| 1639664857 | Athletico Ltd | Physical Therapist | 3819 Rivertown Pkwy Sw Ste 100, Grandville, MI 49418 | 2018-06-29 |
| 1437651916 | Great Lakes Wellness Counseling LLC | Counselor | 2900 Wilson Ave Suite 110, Grandville, MI 49418 | 2018-03-01 |
| 1780111765 | Jenna Sargent | Nurse Practitioner | 2845 44th St Sw, Ste 200, Grandville, MI 49418 | 2017-05-22 |
| 1881132827 | Laura Elizabeth Ramaker | Specialist/Technologist | 2787 Pine Dunes Ct Sw, Wyoming, MI 49418 | 2017-02-10 |
| 1689026130 | Charles Unseld | Hearing Instrument Specialist | O-38 44th St Sw, Grandville, MI 49418 | 2016-07-08 |
| 1972989655 | Laci Dawn Johncock | Physical Therapy Assistant | 2786 56th Street, Wyoming, MI 49418 | 2015-08-05 |
| 1891178570 | Joshua Kolman | Pharmacist | 3434 Century Center Dr Sw, Grandville, MI 49418 | 2015-06-30 |
| 1710368782 | Tracie Medrano- Smith | Family Medicine | 4174 56th St Sw, Wyoming, MI 49418 | 2015-06-15 |
| 1124410808 | Kim Michelle Childress | Counselor | 4565 Wilson Ave Sw Ste 3a, Grandville, MI 49418 | 2015-03-04 |
| Find all providers in zip 49418 | ||||
| Taxonomy Code | 2084P0800X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Psychiatry |
| A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417139692 | Nan Beth Alt | Psychiatry & Neurology | 151 44th Street, S.w., Grandville, MI 49418 | 2007-11-29 |
| 1386677185 | Clinical Psychiatric Medicine PC | Psychiatry & Neurology | 0-151 44th Street Sw, Grandville, MI 49418 | 2006-07-08 |
| 1538115746 | Michael Bernard Karluk | Psychiatry & Neurology | 4211 Parkway Pl Sw, Grandville, MI 49418-2385 | 2006-05-26 |
| 1760649594 | Jonathan James Dargo | Psychiatry & Neurology | 4211 Parkway Pl Sw, Grandville, MI 49418-2695 | 2008-05-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720686165 | Centia Health LLC | Psychiatry & Neurology | 23802 Wintergreen Cir, Novi, MI 48374-3681 | 2020-10-16 |
| 1114524428 | Clarity Behavioral Health Pllc | Psychiatry & Neurology | 7154 Merrybrook, West Bloomfield, MI 48322-4066 | 2020-10-08 |
| 1790395978 | Amiri Psychiatric Services Pllc | Psychiatry & Neurology | 1695 W Saratoga St, Ferndale, MI 48220-3153 | 2020-08-03 |
| 1881211191 | Infinite Wellness Healthcare, Pllc | Psychiatry & Neurology | 19855 Outer Dr Ste 504e, Dearborn, MI 48124-2040 | 2020-07-02 |
| 1528680303 | Emilia Elizabeth Mattioli | Psychiatry & Neurology | 965 Fee Road Room A223, East Lansing, MI 48824 | 2020-05-14 |
| 1447871983 | James O'brien | Psychiatry & Neurology | Msu Psychiatry Residency Program, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2020-05-06 |
| 1083247134 | Actify Neurotherapies, Pllc | Psychiatry & Neurology | 28475 Greenfield Rd Ste 113, Southfield, MI 48076-3034 | 2020-02-18 |
| 1720611734 | Brightside Medical of Michigan, P.C. | Psychiatry & Neurology | Telemedicine Services Only / No Physical Office, Telemedicine Services Only / No Physical, MI 48170 | 2020-02-18 |
| 1922646538 | Sylvia Hanson Md Pllc | Psychiatry & Neurology | 6461 Golden Ln, West Bloomfield, MI 48322-3096 | 2019-12-13 |
| 1740823129 | Tms Wellness Clinic of Michigan Pllc | Psychiatry & Neurology | 5757 W Maple Rd Ste 800-b, West Bloomfield, MI 48322-2277 | 2019-10-18 |
| Find all providers with the same taxonomy | ||||
| City | GRANDVILLE |
| Zip Code | 49418 |
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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.