Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Pine Rest Christian Mental Health Services

Organization Physician Assistant · NPI 1407866569

Pine Rest Christian Mental Health Services provides Physician Assistant services in Grand Rapids, Michigan. Registered with an NPI since 2006.

In the registry since
2006

Practice location Address checks out

300 68th St SE
Grand Rapids, MI 49548-6927
Phone: (616) 455-5000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1407866569
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Diane Fennema — Managed Care Administrator · (616) 281-6372
NPI enumeratedAugust 9, 2006
Last updated in NPPESNovember 4, 2020
Certification dateNovember 4, 2020
Mailing address300 68th St Se, Grand Rapids, MI 49548-6927

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