PINE REST CHRISTIAN MENTAL HEALTH SERVICES (NPI# 1841791357) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841791357 |
| Entity Type | Organization |
| Organization Name | PINE REST CHRISTIAN MENTAL HEALTH SERVICES |
| Practice Address |
300 68th Street Se Grand Rapids MI 49548 |
| Mailing Address |
300 68th St Se Grand Rapids MI 49548-6927 |
| Practice Telephone | 6162816372 |
| Mailing Telephone | 6162816372 |
| Mailing Fax Number | 6162816459 |
| Enumeration Date | 2018-02-21 |
| Last Update Date | 2020-11-04 |
| Authorized Official Name | DIANE FENNEMA (MANAGED CARE ADMINISTRATOR) |
| Authorized Official Telephone | 6162816372 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 324500000X | Substance Abuse Rehabilitation Facility | SA0410417 | MI | Residential Treatment Facilities |
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
SA0410417 | MI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BC/BS SUBSTANCE ABUSE - CAMPUS CLINIC 1 | SA0410417 | 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 |
| 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 |
| 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 |
300 68TH STREET SE |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49548 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386738953 | Sharita Montiez Hall | Social Worker | 300 68th Street Se, Grand Rapids, MI 49548 | 2006-10-03 |
| 1902336100 | Danielle Pariesee Zazaian | Psychiatry & Neurology | 300 68th Street Se, Pine Rest Christian Mental Health Services, Grand Rapids, MI 49548 | 2017-06-20 |
| 1912437245 | Zachary David Loy | Psychiatry & Neurology | 300 68th Street Se, Pine Rest Christian Mental Health Services, Grand Rapids, MI 49548 | 2017-06-19 |
| 1770013203 | Alexandra Lynn Tepkasetkul | Psychiatry & Neurology | 300 68th Street Se, Pine Rest Christian Mental Health Services, Grand Rapids, MI 49548 | 2017-06-18 |
| 1982134623 | Weston Mark Anderson | Psychiatry & Neurology | 300 68th Street Se, Pine Rest Christian Mental Health Services, Grand Rapids, MI 49548 | 2017-06-15 |
| 1770013559 | Russell Brian Fridson | Psychiatry & Neurology | 300 68th Street Se, Pine Rest Christian Mental Health Services, Grand Rapids, MI 49548 | 2017-06-14 |
| 1861921041 | Heidi Juel Vrolijk | Psychiatry & Neurology | 300 68th Street Se, Pine Rest Christian Mental Health Services, Grand Rapids, MI 49548 | 2017-06-09 |
| 1477082931 | Ryan Joseph Yoon | Psychiatry & Neurology | 300 68th Street Se, Pine Rest Christian Mental Health Services, Grand Rapids, MI 49548 | 2017-06-08 |
| 1679002497 | Todd Matthew Simmons | Psychiatry & Neurology | 300 68th Street Se, Pine Rest Christian Mental Health Services, Grand Rapids, MI 49548 | 2017-06-06 |
| 1295264034 | Alisha Renee Thibault | Psychiatry & Neurology | 300 68th Street Se, Pine Rest Christian Mental Health Services, Grand Rapids, MI 49548 | 2017-06-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205319811 | Pooja Patel | Social Worker | Spectrum Community Services, 3353 Lousma Dr. Se, Wyoming, MI 49548 | 2018-09-10 |
| 1063906865 | Kimberly Eccher | Physician Assistant | 300 68th St. Se, Grand Rapids, MI 49548 | 2018-06-15 |
| 1871099481 | Baymark of Michigan, Inc. | Clinic/Center | 5500 Division Avenue Se, Kentwood, MI 49548 | 2018-04-03 |
| 1629507801 | Laura Marie Quennoz | Psychiatry & Neurology | Pine Rest Christian Mental Health Services, 300 68th Street Se, Grand Rapids, MI 49548 | 2017-06-09 |
| 1821548504 | Alison Anderson | Technician, Other | 103 Roth St Se, Grand Rapids, MI 49548 | 2016-10-06 |
| 1831540152 | Jesse Aubil | Counselor | 264 Montebello St. Se 49548, Grand Rapids, MI 49548 | 2016-06-28 |
| 1306237920 | Sarah Benton | Social Worker | 225 Colrain St Sw, 2, Grand Rapids, MI 49548 | 2015-02-18 |
| 1578996856 | Karen Marie Irving | Social Worker | 3353 Lousma Dr. Se, Wyoming, MI 49548 | 2013-08-09 |
| 1740348044 | Robert Kenneth Richmond | Preventive Medicine | 551 36th Street. Se, Wyoming, MI 49548 | 2006-12-05 |
| 1255432977 | Rodney Ray Senneker | Podiatrist | 6703 S Division Ave, Grand Rapids, MI 49548 | 2006-09-26 |
| Find all providers in zip 49548 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891302717 | Paige J Welch | Counselor | 1509 Diamond Ave Ne, Grand Rapids, MI 49505-5217 | 2020-09-24 |
| 1588277040 | Gregory Dean Retzlaff | Counselor | 2043 Rowe Ave Ne, Grand Rapids, MI 49505-4238 | 2020-08-25 |
| 1699392555 | Duane Stanley Helmer | Counselor | First Call for Help of Itasca County, 1707 Nw 4th Street Suite B, Grand Rapids, MN 55744 | 2020-06-26 |
| 1649779927 | Larry Mitchell | Counselor | 1960 Millbrook St Se, Grand Rapids, MI 49508-2636 | 2018-02-01 |
| 1235657388 | Courtney Albin | Counselor | 2504 Ardmore St Se Ste 202b, Grand Rapids, MI 49506-4901 | 2017-09-08 |
| 1649712001 | Alexander C Meyer | Counselor | 1200 S Pokegama Ave Ste 160, Grand Rapids, MN 55744-4296 | 2016-11-15 |
| 1871048934 | Nicole Nutt | Counselor | 32 Winter Ave Sw Apt 228, Grand Rapids, MI 49504-6488 | 2016-08-18 |
| 1306247564 | Krystal Strotbaum | Counselor | 5242 Plainfield Ave Ne Ste E, Grand Rapids, MI 49525-1084 | 2014-09-08 |
| 1710390372 | Laura Meeker Wicksall | Counselor | 1430 Robinson Rd Se Ste 206, Grand Rapids, MI 49506-1723 | 2014-06-11 |
| 1023358314 | Carole Lynn Walters | Counselor | 959 Wealthy St Se, Grand Rapids, MI 49506-2519 | 2013-02-22 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49548 |
Please comment or provide details below to improve the information on PINE REST CHRISTIAN MENTAL HEALTH SERVICES.
| 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.