OrganizationActive
Pine Rest Christian Mental Health Services
NPI 1679777049 · Addiction Medicine (Internal Medicine) Physician · Grand Rapids, MI
Provider details
- NPI number
- 1679777049
- Entity type
- Organization
- Primary specialty
- Addiction Medicine (Internal Medicine) PhysicianAllopathic & Osteopathic Physicians
- Parent organization
- Pine Rest Christian Mental Health Services
- Organization subpart
- Yes
- Authorized official
- Diane Fennema, Managed Care Administrator(616) 281-6372
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Behavioral Health & Social Service Providers
- Mental Health Counselor101YM0800X
Behavioral Health & Social Service Providers
- Psychologist103T00000X
Behavioral Health & Social Service Providers
- Social Worker104100000X
Behavioral Health & Social Service Providers
- Internal Medicine Physician207R00000X
Allopathic & Osteopathic Physicians
Practice location
243 68th St Se
Grand Rapids, MI 49548-6924
Phone: (616) 281-6836
Approximate (ZIP-level) locationGet directions
Mailing address
300 68th St Se
Grand Rapids, MI 49548-6927
Registry dates
- Enumerated
- 2007-06-12
- Last updated
- 2020-11-04
- Certified
- 2020-11-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.