PINE REST CHRISTIAN MENTAL HEALTH SERVICES (NPI# 1598138810) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598138810 |
| Entity Type | Organization |
| Organization Name | PINE REST CHRISTIAN MENTAL HEALTH SERVICES |
| Practice Address |
1870 Leonard St Ne Grand Rapids MI 49505-5650 |
| Mailing Address |
300 68th St Se Grand Rapids MI 49548-6927 |
| Practice Telephone | 6169569619 |
| Mailing Telephone | 6164555270 |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2020-11-04 |
| Authorized Official Name | DIANE FENNEMA (MANAGED CARE ADMINISTATOR) |
| Authorized Official Telephone | 6162816372 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YP2500X |
Counselor Specialization: Professional |
MI | Behavioral Health & Social Service Providers | |
| N | 103T00000X | Psychologist | MI | Behavioral Health & Social Service Providers | |
| N | 104100000X | Social Worker | MI | Behavioral Health & Social Service Providers | |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
MI | Allopathic & Osteopathic Physicians | |
| N | 363L00000X | Nurse Practitioner | MI | Physician Assistants & Advanced Practice Nursing Providers | |
| Y | 363A00000X | Physician Assistant | MI | Physician Assistants & Advanced Practice Nursing Providers |
| 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 |
| 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 |
| 1487837506 | Pine Rest Christian Mental Health Services | Psychiatry & Neurology | 300 68th St Se, Grand Rapids, MI 49548-6927 | 2007-12-12 |
| 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 |
1870 LEONARD ST NE |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49505-5650 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992898001 | Pamela Ann Wright-hachet | Social Worker | 1870 Leonard St Ne, Grand Rapids, MI 49505-5650 | 2006-10-02 |
| 1275171837 | Cindy S Urban | Counselor | 1870 Leonard St Ne, Grand Rapids, MI 49505-5650 | 2019-12-13 |
| 1013560085 | Jason R Rood | Social Worker | 1870 Leonard St Ne, Grand Rapids, MI 49505-5650 | 2019-07-18 |
| 1326522293 | Kristy Lee Gunnink | Counselor | 1870 Leonard St Ne, Grand Rapids, MI 49505-5650 | 2018-09-18 |
| 1629505268 | Cassandra Marie Degraaf | Social Worker | 1870 Leonard St Ne, Grand Rapids, MI 49505-5650 | 2017-05-14 |
| 1972057081 | Marci Gleason | Social Worker | 1870 Leonard St Ne, Grand Rapids, MI 49505-5650 | 2016-08-05 |
| 1598193773 | Michele Rae Anne Jackson | Social Worker | 1870 Leonard St Ne, Grand Rapids, MI 49505-5650 | 2013-10-24 |
| 1275886426 | Ian Nelson | Psychologist | 1870 Leonard St Ne, Grand Rapids, MI 49505-5650 | 2012-10-24 |
| 1922359710 | Cherie M Keating | Social Worker | 1870 Leonard St Ne, Grand Rapids, MI 49505-5650 | 2012-09-20 |
| 1043570344 | Wendy Bilgen | Social Worker | 1870 Leonard St Ne, Grand Rapids, MI 49505-5650 | 2012-05-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285276097 | Molly Beth Kerkstra | Home Health Aide | 1115 Ball Ave Nw, Grand Rapids, MI 49505 | 2019-10-14 |
| 1154849677 | Roshawn Nichol Whitley | Technician | 891 Maryland Ave, Grand Rapids, MI 49505 | 2017-09-05 |
| 1447778923 | Kelly Benzin-brinks | Social Worker | 1965 3 Mile Rd Ne, Grand Rapids, MI 49505 | 2017-09-05 |
| 1033560404 | Taylor Nolan Boyd | Speech-Language Pathologist | 400 Ann St Ne Ste 106a, Grand Rapids, MI 49505 | 2016-06-28 |
| 1023465002 | Calvin Athy | Counselor | 1101 Ballave Ne, Grand Rapids, MI 49505 | 2016-05-19 |
| 1821456682 | Kelly Van Huisen | Counselor | 1115 Ball Avenue Ne, Building B, Grand Rapids, MI 49505 | 2016-02-08 |
| 1780051102 | Mark Squeteri | Social Worker | 1345 Monroe Ave Nw Ste 234, Grand Rapids, MI 49505 | 2015-09-02 |
| 1346637337 | Shelby Fullington | Social Worker | 1011 Ball Ave Ne, Grand Rapids, MI 49505 | 2015-04-17 |
| 1457745325 | Lester Anderson II | Social Worker | 1115 Ball Ave, Grand Rapids, MI 49505 | 2015-03-27 |
| 1730570151 | Nicole Brown | Counselor | 1345 Monroe Ave Nw Ste 204, Grand Rapids, MI 49505 | 2015-02-06 |
| Find all providers in zip 49505 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609473198 | Rachel M. Graziano | Physician Assistant | 18 Lowell Ave Ne, Grand Rapids, MI 49503-3760 | 2020-10-07 |
| 1811537269 | Joseph Salvatore Giovannucci | Physician Assistant | 145 Michigan St Ne Ste 2230, Grand Rapids, MI 49503-2562 | 2020-01-14 |
| 1326685686 | Mitchell Lebel | Physician Assistant | 932 Fulton St E Unit 1, Grand Rapids, MI 49503-3565 | 2019-12-05 |
| 1326680331 | Emily Wallace | Physician Assistant | 1661 Philadelphia Ave Se, Grand Rapids, MI 49507-2251 | 2019-10-10 |
| 1124688197 | Leeann Marie Kuehn | Physician Assistant | 218 Warren Ave Se, Grand Rapids, MI 49506-1582 | 2019-06-20 |
| 1770057549 | Shelby Elizabeth Hunt | Physician Assistant | 100 Michigan St Ne # Mc9017, Grand Rapids, MI 49503-2560 | 2019-01-15 |
| 1063906865 | Kimberly Eccher | Physician Assistant | 300 68th St. Se, Grand Rapids, MI 49548 | 2018-06-15 |
| 1174029094 | Katrina Ann Brummel | Physician Assistant | 555 Midtowne St Ne Ste 110, Grand Rapids, MI 49503-5731 | 2018-03-30 |
| 1902312994 | Aaron Michaud | Physician Assistant | 301 Barclay Ave Ne, Grand Rapids, MI 49503 | 2017-12-28 |
| 1538687215 | Sonia Nicola | Physician Assistant | 4100 Embassy Dr Se Ste 400, Grand Rapids, MI 49546-2416 | 2017-09-01 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49505 |
Please comment or provide details below to improve the information on PINE REST CHRISTIAN MENTAL HEALTH SERVICES.
| 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.