1841480134 NPI number — PSYCHIATRIC ASSOCIATES OF WEST MICHIGAN, PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841480134 NPI number — PSYCHIATRIC ASSOCIATES OF WEST MICHIGAN, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCHIATRIC ASSOCIATES OF WEST MICHIGAN, PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841480134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 140241
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49514-0241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-735-1505
Provider Business Mailing Address Fax Number:
616-675-1153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6555 HERON BAY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAUGATUCK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49453-9687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-719-4488
Provider Business Practice Location Address Fax Number:
616-719-4480
Provider Enumeration Date:
08/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALEXANDER
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
616-735-1505

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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