| NPI | 1467840553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE G FENNEMA Managed Care Administrator 616-281-6372 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2014-12-26 |
| Last Update Date | 2020-11-04 |