| NPI | 1982672762 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN LARUE VP Contracting 616-281-6373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 283Q00000X Psychiatric Hospital |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103G00000X Clinical Neuropsychologist | |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 106H00000X Marriage & Family Therapist | |
| 163W00000X Registered Nurse | |
| 207L00000X Anesthesiology | |
| 207R00000X Internal Medicine | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2024-04-16 |