MR. MARK FREDERIC PETERSON I (NPI# 1841474012) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1841474012 |
Entity Type | Individual |
Full Name | MR. MARK FREDERIC PETERSON I |
Practice Address |
3351 36th St Grand Rapids MI 49331 |
Mailing Address |
2285 Christine Ct Se Grand Rapids MI 49546 |
Practice Telephone | 6168315659 |
Mailing Telephone | 6168315659 |
Enumeration Date | 2007-12-24 |
Last Update Date | 2007-12-24 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 6802071051 | MI | Residential Treatment Facilities |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1164069696 | Mark Alan Peterson | In Home Supportive Care | 5870 Nw 54th Ct, Johnston, IA 50131-1418 | 2019-12-03 |
1780877258 | Mark A. Peterson | Counselor | 7322 Scenic Oaks Cir, Austin, TX 78745-5217 | 2007-08-19 |
1871702076 | Mark Clayton Peterson | Dentist | 1600 W Sunset Rd Ste B, Henderson, NV 89014-2655 | 2007-05-22 |
1558481366 | Mark Theodore Peterson | Specialist | 5712 Newburg Rd, Rockford, IL 61108-6707 | 2007-03-29 |
1073608170 | Mark A Peterson | Dentist | 7740 Bay St, Suite # 1, Sebastian, FL 32958-3427 | 2006-10-04 |
1689782864 | Mark L Peterson | Dentist | 127 1/2 E Short St, Rigby, ID 83442-1422 | 2006-08-28 |
1528013661 | Mark Edward Peterson | Dentist | 2440 Gaynor Nw, Grand Rapids, MI 49544-1830 | 2006-05-24 |
1699763607 | Mark Delano Peterson | Orthopaedic Surgery | 1311 E Barnett Rd, Ste 201, Medford, OR 97504-8225 | 2005-10-12 |
1477551836 | Mark Dean Peterson | Chiropractor | 5406 Alderson St, Schofield, WI 54476-2264 | 2005-07-11 |
1477043842 | Mark Peterson | Student in an Organized Health Care Education/Training Program | 1115 20th St Ste 205, Huntington, WV 25703-2071 | 2018-05-11 |
Street Address |
3351 36TH ST |
City | GRAND RAPIDS |
State | MI |
Zip Code | 49331 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1295173771 | Heather Marie Jones | Optometrist | 915 W. Green St Ste 101, Hastings, MI 49331 | 2013-06-06 |
1184732323 | Alivio Corporation | Durable Medical Equipment & Medical Supplies | 901 W. Main Street, Suite C, Lowell, MI 49331 | 2006-08-28 |
1740707637 | Parker Liu | Pharmacist | 11980 Fulton St E, Lowell, MI 49331 | 2017-08-23 |
1962482653 | Martin D Vredenburg | Dentist | 1150 N Hudson St, Lowell, MI 49331-1000 | 2006-01-19 |
1407140197 | Spectrum Health Primary Care Partners | Internal Medicine | 1150 N Hudson St, Lowell, MI 49331-1000 | 2011-05-31 |
1508034141 | Lowell Medical Specialists, PC | Internal Medicine | 1150 N Hudson St, Lowell, MI 49331-1000 | 2008-02-18 |
1740660315 | Patricia Sellner | Specialist/Technologist | 990 N Hudson St, Lowell, MI 49331-1006 | 2015-06-08 |
1508327370 | Lydia Joan Gerard | Registered Nurse | 1060 Hunt St, Lowell, MI 49331-1079 | 2019-03-26 |
1154847184 | Family Dentistry of Lowell | Dentist | 147 N Center St, Lowell, MI 49331-1207 | 2017-08-22 |
1669515813 | Ann Cathleen Wilson | Dentist | 147 N Center St, Lowell, MI 49331-1207 | 2007-02-15 |
Find all providers in zip 49331 |
Taxonomy Code | 320900000X |
Grouping | Residential Treatment Facilities |
Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1851830947 | Royal Care Home LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 507 Fuller Ave Se, Grand Rapids, MI 49506-2526 | 2017-02-22 |
1447799259 | Kleck Afc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 631 3 Mile Rd Ne, Grand Rapids, MI 49505-3362 | 2017-02-14 |
1528260700 | Real Life Living Services, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2920 Fuller Ave Ne Ste 103, Grand Rapids, MI 49505-3458 | 2007-06-01 |
1366799900 | Hope Network Behavoiral Health Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3333 36th St Se, Grand Rapids, MI 49512-2809 | 2012-08-14 |
1376722868 | Kent Residential Centers, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1225 Lake Dr Se, Grand Rapids, MI 49506-1656 | 2007-10-31 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144855123 | Hope Shores, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1383 E Maple Ave, Burton, MI 48529-2059 | 2020-03-10 |
1760030183 | Specially Made Co. LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 845 E Summerfield Glen Cir, Ann Arbor, MI 48103-9161 | 2019-08-28 |
1033776919 | South Coast Home LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 72633 M 43, South Haven, MI 49090-8734 | 2019-05-25 |
1275001448 | St. Jude's Assisted Living | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 509 S 22nd St, Escanaba, MI 49829-2247 | 2018-11-06 |
1457826315 | Northrop Loving Care | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 17777 Northrop St, Detroit, MI 48219-2321 | 2018-10-08 |
1548745961 | Residential Opportunities Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 612 Landsdowne Ave, Portage, MI 49002-0556 | 2018-10-02 |
1134604051 | Unity Group II LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 63 Wood Dr, Coldwater, MI 49036-1046 | 2018-09-26 |
1578048401 | Unity Group V LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 69 Wood Dr, Coldwater, MI 49036-1046 | 2018-09-26 |
1417432337 | Unity Group IIi LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1831 Case Dr, Union City, MI 49094-9348 | 2018-09-26 |
1033694963 | Unity Group Iv LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 126 Gail Ann Dr, Coldwater, MI 49036-9327 | 2018-09-26 |
Find all providers with the same taxonomy |
City | GRAND RAPIDS |
Zip Code | 49331 |
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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.