| NPI | 1487837506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE FENNEMA Managed Care Administator 616-281-6372 |
| Organization Subpart ? | |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 103T00000X Psychologist |
| 104100000X Social Worker | |
| 207R00000X Internal Medicine | |
| 207RA0401X Internal Medicine Addiction Medicine | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 283Q00000X Psychiatric Hospital | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2020-11-04 |