Mr. Mark Frederic Peterson I
Mr. Mark Frederic Peterson I is an Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Grand Rapids, Michigan. Practices as a sole proprietor. Licensed in Michigan.
- Licensed in
- MI
- In the registry since
- 2007
Practice location Address checks out
3351 36th StGrand Rapids, MI 49331
Phone: (616) 831-5659
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Specialties & licences
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (primary) | Taxonomy 320900000X · Licence 6802071051 (MI) |
|---|
Record details
| NPI number | 1841474012 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | December 24, 2007 |
| Last updated in NPPES | December 24, 2007 |
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