| NPI | 1235895897 |
|---|---|
| Other Name | PINE REST COMMUNITY SERVICES SUBSTANCE ABUSE |
| Entity Type | Organization |
| Authorized Contact | DIANE M FENNEMA Managed Care Administrator 616-281-6372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 103T00000X Psychologist | |
| 103TC0700X Psychologist Clinical | |
| 1041C0700X Social Worker Clinical | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2021-11-09 |
| Last Update Date | 2022-03-11 |