PINE REST CHRISTIAN MENTAL HEALTH SERVICES (NPI# 1467840553) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467840553 |
| Entity Type | Organization |
| Organization Name | PINE REST CHRISTIAN MENTAL HEALTH SERVICES |
| Practice Address |
17325 Van Wagoner Rd Spring Lake MI 49456-9702 |
| Mailing Address |
300 68th St Se Grand Rapids MI 49548-6927 |
| Practice Telephone | 6168475145 |
| Mailing Telephone | 6162816372 |
| Enumeration Date | 2014-12-26 |
| Last Update Date | 2020-11-04 |
| Authorized Official Name | DIANE G 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 | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 101YP2500X |
Counselor Specialization: Professional |
Behavioral Health & Social Service Providers | ||
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| N | 104100000X | Social Worker | Behavioral Health & Social Service Providers | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 283Q00000X | Psychiatric Hospital | Hospitals |
| 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 |
| 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 |
| 1487837506 | Pine Rest Christian Mental Health Services | Psychiatry & Neurology | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2007-12-12 |
| 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 |
17325 VAN WAGONER RD |
| City | SPRING LAKE |
| State | MI |
| Zip Code | 49456-9702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336188556 | Katherine Ann Jawor | Psychiatry & Neurology | 17325 Van Wagoner Rd, Spring Lake, MI 49456-9702 | 2006-06-05 |
| 1538768643 | Karen Jean Alkema | Counselor | 17325 Van Wagoner Rd, Spring Lake, MI 49456-9702 | 2020-10-20 |
| 1508119892 | Jordan Charles Engelhard | Psychologist | 17325 Van Wagoner Rd, Spring Lake, MI 49456-9702 | 2012-10-24 |
| 1346523131 | Sara Nicole Patzer | Social Worker | 17325 Van Wagoner Rd, Spring Lake, MI 49456-9702 | 2011-09-28 |
| 1811903321 | Derek L Burt | Nurse Practitioner | 17325 Van Wagoner Rd, Spring Lake, MI 49456-9702 | 2006-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376066001 | Kathleen Ann Bates | Nurse Practitioner | 16036 Baird Dr, Spring Lake, MI 49456 | 2017-07-25 |
| 1174859763 | David A Buursma | Physical Therapist | 16140 148th Avenue, Spring Lake Community Fitness & Aquatic Center, Spring Lake, MI 49456 | 2009-11-02 |
| 1720314552 | Arthur Linwood Brown II | Surgery | 18925 North Shore Dr., Spring Lake, MI 49456 | 2009-10-29 |
| 1700050531 | Ann Holmgren Harris | Clinical Nurse Specialist | 17353 Hazel St, Suite 212, Spring Lake, MI 49456 | 2008-04-14 |
| 1932320421 | Julie A Bench | Physical Therapist | 15414 Stoneridge Ct, Spring Lake, MI 49456 | 2007-05-01 |
| 1730304130 | Phillip Allen Morse | Pharmacist | 603 E Savidge, Spring Lake, MI 49456 | 2007-04-13 |
| 1821125592 | Patrick Scott Karwowski | Pharmacist | 603 E Savidge St, Spring Lake, MI 49456 | 2007-02-28 |
| 1528126521 | Debra Kaye Cargo | Social Worker | 107 South Division, Spring Lake, MI 49456 | 2006-12-04 |
| 1396821377 | Hometown Pharmacy Inc | Pharmacy | 17717 174th Ave, Spring Lake, MI 49456 | 2006-10-31 |
| 1710071360 | Link Dephouse | Physical Therapist | 16200 Old Orchard Dr, Spring Lake, MI 49456 | 2006-10-03 |
| Find all providers in zip 49456 | ||||
| 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 |
|---|---|---|---|---|
| 1881085264 | Fayetteville Va Medical Cener | Psychiatric Hospital | 1111 Shell Dr, Apt 60, Spring Lake, NC 28390-2050 | 2015-02-06 |
| 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 | SPRING LAKE |
| Zip Code | 49456 |
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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.