EASTERN CLINIC PLLC (NPI# 1942675426) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942675426 |
| Entity Type | Organization |
| Organization Name | EASTERN CLINIC PLLC |
| Practice Address |
1555 Eastern Ave Se Grand Rapids MI 49507-2055 |
| Practice Telephone | 6162436262 |
| Practice Fax Number | 6162436969 |
| Mailing Telephone | 6162436262 |
| Mailing Fax Number | 6162436969 |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2015-12-09 |
| Authorized Official Name | MR. DARYL SMITH (PROGRAM DIRECTOR) |
| Authorized Official Telephone | 6162436262 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2800X |
Clinic/Center Specialization: Methadone Clinic |
SA0410165 | MI | Ambulatory Health Care Facilities |
| Street Address |
1555 EASTERN AVE SE |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49507-2055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487156956 | Kristen Zvirbulis Keeter | Physical Therapist | 625 Kenmoor Ave. Se Ste 306, Grand Rapids, MI 49507 | 2018-03-01 |
| 1508371758 | Vanessa Woodard | Case Manager/Care Coordinator | 1939 S. Division Ave., Grand Rapids, MI 49507 | 2017-12-11 |
| 1306350624 | Courtney Nicole Porter | Social Worker | 1979 S Division Ave., Grand Rapids, MI 49507 | 2017-11-22 |
| 1518496900 | 733 Prince LLC | Custodial Care Facility | 733 Prince St Se, Grand Rapids, MI 49507 | 2017-06-08 |
| 1720515406 | Tiffanie Ryder | Massage Therapist | 1110 Merrified St, Grand Rapids, MI 49507 | 2017-05-12 |
| 1619404308 | Shedrice's Afc | Respite Care | 246 Powell Se Ave, Grand Rapids, MI 49507 | 2017-05-12 |
| 1992171748 | Richard Lavell Flowers | Non-emergency Medical Transport (VAN) | 1447 Elliott, Grand Rapids, MI 49507 | 2015-08-17 |
| 1982096087 | Jordana Seebeck | Social Worker | 1939 S. Division Se, Grand Rapids, MI 49507 | 2015-02-26 |
| 1083973135 | Carla May Waite | Social Worker | 1939 South Division, Grand Rapids, MI 49507 | 2012-05-10 |
| 1740550037 | Jamie Lee Dalton | Social Worker | 2017 College Ave Se, Grand Rapids, MI 49507 | 2012-01-04 |
| Find all providers in zip 49507 | ||||
| Taxonomy Code | 261QM2800X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Methadone Clinic |
| An entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952827107 | Nupoint Services LLC | Clinic/Center | 1620 44th Street Se, Grand Rapids, MI 49508 | 2017-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871099481 | Baymark of Michigan, Inc. | Clinic/Center | 5500 Division Avenue Se, Kentwood, MI 49548 | 2018-04-03 |
| 1881118206 | Harrison Udensi Igwe | Clinic/Center | 522 South Maple Stree, Ann Arbor, MI 48103 | 2017-07-27 |
| 1740653641 | Ann Arbor Treatment Services, LLC | Clinic/Center | 4673 Washtenaw Ave, Ann Arbor, MI 48108 | 2015-11-02 |
| 1902284193 | Therapeutics, LLC | Clinic/Center | 50222 Dennis Ct, Wixom, MI 48393-2023 | 2015-05-08 |
| 1578960480 | Changes1, Pllc | Clinic/Center | 19940 Conant, Ste A, B, & C, Detroit, MI 48234-1494 | 2014-11-21 |
| 1669874418 | The Brighton Center, Inc. | Clinic/Center | 2512 Harte Dr, Brighton, MI 48114-7002 | 2014-09-24 |
| 1275969990 | Harriet Alexander | Clinic/Center | 20724 Eureka Rd., Taylor, MI 48180 | 2013-09-26 |
| 1922383397 | Rainbow Center Inc. | Clinic/Center | 20724 Eureka Rd, Taylor, MI 48180-5313 | 2011-10-18 |
| 1306078084 | Crc Recovery, Inc. | Clinic/Center | 2025 S Washington Ave Ste 210, Lansing, MI 48910-0817 | 2009-08-14 |
| 1598932253 | Michigan Therapeutic Consultants PC | Clinic/Center | 4273 Corporate Way, Mount Pleasant, MI 48858 | 2008-05-13 |
| Find all providers with the same taxonomy | ||||
| City | GRAND RAPIDS |
| Zip Code | 49507 |
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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.