| NPI | 1982672762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN LARUE VP Contracting 616-281-6373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207L00000X Anesthesiology | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 101YP2500X Counselor, Professional | |
| 235Z00000X Speech-Language Pathologist, | |
| 225100000X Physical Therapist | |
| 103G00000X Clinical Neuropsychologist | |
| 103T00000X Psychologist | |
| 363L00000X Nurse Practitioner | |
| 225X00000X Occupational Therapist | |
| 363A00000X Physician Assistant | |
| 104100000X Social Worker | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2025-11-11 |