| NPI | 1952818551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE FENNEMA Managed Care Administrator 616-281-6372 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| 363A00000X Physician Assistant | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 1041C0700X Social Worker, Clinical | |
| 207RA0401X Internal Medicine, Addiction Medicine | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2020-11-04 |