PINE REST CHRISTIAN MENTAL HEALTH SERVICES (NPI# 1487837506) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487837506 |
| Entity Type | Organization |
| Organization Name | PINE REST CHRISTIAN MENTAL HEALTH SERVICES |
| Practice Address |
300 68th St Se Grand Rapids MI 49548-6927 |
| Practice Telephone | 6164555000 |
| Mailing Telephone | 6164555000 |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2020-11-04 |
| Authorized Official Name | DIANE FENNEMA (MANAGED CARE ADMINISTATOR) |
| Authorized Official Telephone | 6162816372 |
| Is Organization Subpart | Y |
| Parent Organization Name | PINE REST CHRISTIAN MENTAL HEALTH SERVICES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 283Q00000X | Psychiatric Hospital | Hospitals | ||
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| N | 104100000X | Social Worker | Behavioral Health & Social Service Providers | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BC/BS GNERAL MEDICINE | OD14837 | 01 |
| MI | BC/BS PSYCHIATRY-MULTI SP | OD16083 | 01 |
| MI | BC/BS SOCIAL WORKER | OD16222 | 01 |
| MI | BC/BS NURSE PRACTIONER | OD11133 | 01 |
| MI | BC/BS PSYCHIATRY | OD17625 | 01 |
| MI | BC/BS PSYCHOLOGIST | OD16189 | 01 |
| MI | BC/BS PEDIATRICS | OD14836 | 01 |
| MI | BC/BS MA, LLP, DOCTORAL | OD11275 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154339521 | Pine Rest Christian Mental Health Services | Psychologist | 550 - 3 Mile Rd Nw, Grand Rapids, MI 49544-1673 | 2006-08-03 |
| 1841791357 | Pine Rest Christian Mental Health Services | Substance Abuse Rehabilitation Facility | 300 68th Street Se, Grand Rapids, MI 49548 | 2018-02-21 |
| 1952818551 | Pine Rest Christian Mental Health Services | Substance Abuse Rehabilitation Facility | 450 Meadow Run Dr, Hastings, MI 49058-9053 | 2018-01-04 |
| 1619341310 | Pine Rest Christian Mental Health Services | Counselor | 9090 S Rodgers Ct Se, Caledonia, MI 49316-8052 | 2015-11-18 |
| 1598138810 | Pine Rest Christian Mental Health Services | Counselor | 1870 Leonard St Ne, Grand Rapids, MI 49505-5650 | 2015-11-09 |
| 1386015683 | Pine Rest Christian Mental Health Services | Counselor | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2015-10-13 |
| 1467840553 | Pine Rest Christian Mental Health Services | Nurse Practitioner | 17325 Van Wagoner Rd, Spring Lake, MI 49456-9702 | 2014-12-26 |
| 1821414566 | Pine Rest Christian Mental Health Services | Counselor | 1350 W Centre Ave, Portage, MI 49024-5361 | 2014-03-05 |
| 1467873414 | Pine Rest Christian Mental Health Services | Speech-Language Pathologist | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2013-12-18 |
| 1427216241 | Pine Rest Christian Mental Health Services | Counselor | 4294 Laurel Dr, Lake Odessa, MI 48849-9423 | 2008-05-29 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | 300 68th St Se, Grand Rapids, MI 49548-6927 |
| Iowa Business Entities | PINE REST CHRISTIAN MENTAL HEALTH SERVICES | 300 68th St Se, Grand Rapids, MI 49548 |
| Street Address |
300 68TH ST SE |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49548-6927 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114920550 | Emergency Physicians Inc PC | General Practice | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2005-05-31 |
| 1235742768 | Robert Milton Hughes | Physician Assistant | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-08-25 |
| 1992317580 | Jacob Alan Lowe | Psychologist | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-08-17 |
| 1922619063 | Jennifer Nicole Oconnor | Social Worker | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-08-12 |
| 1407464670 | Christina Joy Weaver | Physician Assistant | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-07-14 |
| 1780200436 | Wendy Forrest | Psychiatry & Neurology | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-06-18 |
| 1003430877 | Cory Manoogian | Psychiatry & Neurology | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-06-08 |
| 1992329650 | Amy Joy Smith | Psychologist | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-05-29 |
| 1134743800 | Brendan Mcneilly | Psychiatry & Neurology | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-05-29 |
| 1467075176 | Luke Vander Wal | Psychologist | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2020-05-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205319811 | Pooja Patel | Social Worker | Spectrum Community Services, 3353 Lousma Dr. Se, Wyoming, MI 49548 | 2018-09-10 |
| 1063906865 | Kimberly Eccher | Physician Assistant | 300 68th St. Se, Grand Rapids, MI 49548 | 2018-06-15 |
| 1871099481 | Baymark of Michigan, Inc. | Clinic/Center | 5500 Division Avenue Se, Kentwood, MI 49548 | 2018-04-03 |
| 1629507801 | Laura Marie Quennoz | Psychiatry & Neurology | Pine Rest Christian Mental Health Services, 300 68th Street Se, Grand Rapids, MI 49548 | 2017-06-09 |
| 1821548504 | Alison Anderson | Technician, Other | 103 Roth St Se, Grand Rapids, MI 49548 | 2016-10-06 |
| 1831540152 | Jesse Aubil | Counselor | 264 Montebello St. Se 49548, Grand Rapids, MI 49548 | 2016-06-28 |
| 1306237920 | Sarah Benton | Social Worker | 225 Colrain St Sw, 2, Grand Rapids, MI 49548 | 2015-02-18 |
| 1578996856 | Karen Marie Irving | Social Worker | 3353 Lousma Dr. Se, Wyoming, MI 49548 | 2013-08-09 |
| 1740348044 | Robert Kenneth Richmond | Preventive Medicine | 551 36th Street. Se, Wyoming, MI 49548 | 2006-12-05 |
| 1386738953 | Sharita Montiez Hall | Social Worker | 300 68th Street Se, Grand Rapids, MI 49548 | 2006-10-03 |
| Find all providers in zip 49548 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912427402 | Stephen Gunnink | Pediatrics | 100 Michigan St. Se, Grand Rapids, MI 49503-2527 | 2017-06-26 |
| 1003336595 | Cory Minier Schmidt | Pediatrics | 330 Barclay Ave Ne Ste 330, Grand Rapids, MI 49503-2556 | 2017-06-26 |
| 1093165144 | David Jacob Hoogstra | Pediatrics | 100 Michigan St Ne # Mc085, Grand Rapids, MI 49503-2560 | 2016-06-20 |
| 1063895845 | Megan Elizabeth Conway | Pediatrics | 100 Michigan St Ne # Mc13, Grand Rapids, MI 49503-2560 | 2015-06-30 |
| 1205188653 | Vernon D. Vaandrager | Pediatrics | 3760 Ravine Vista Dr. Se, Grand Rapids, MI 49508-8867 | 2012-10-10 |
| 1386907491 | Jennifer Christine Curtis | Pediatrics | 35 Michigan St Ne Ste 5301, Grand Rapids, MI 49503-2530 | 2012-06-22 |
| 1942597729 | Miranda Louise Hillard | Pediatrics | 330 Barclay, Suite 300, Grand Rapids, MI 49503-2527 | 2011-06-30 |
| 1942509278 | Julie Ann Kirby | Pediatrics | 100 Michigan St Ne # Mc169, Grand Rapids, MI 49503-2560 | 2011-03-25 |
| 1306156443 | Spectrum Health Primary Care Partners | Pediatrics | 545 Michigan St Ne, Suite 203, Grand Rapids, MI 49503-5727 | 2010-10-07 |
| 1649583675 | Cheryl Lynn Dyksen | Pediatrics | 100 Michigan St Ne # 13, Grand Rapids, MI 49503-2560 | 2010-07-19 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49548 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.