| NPI | 1821414566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE FENNEMA Managed Care Administrator 616-281-6372 |
| Organization Subpart ? | No |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital (Licence: MI 1080000018) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional | |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: MI SA0390191) | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2014-03-05 |
| Last Update Date | 2020-11-04 |