Healthcare Provider Details

I. General information

NPI: 1417005257
Provider Name (Legal Business Name): RELIANCE COMMUNITY CARE PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 RAYBROOK SE SUITE 203
GRAND RAPIDS MI
49546-5783
US

IV. Provider business mailing address

2100 RAYBROOK SE SUITE 203
GRAND RAPIDS MI
49546-5783
US

V. Phone/Fax

Practice location:
  • Phone: 616-956-9440
  • Fax: 616-954-1522
Mailing address:
  • Phone: 616-956-9440
  • Fax: 616-954-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number4508891
License Number StateMI

VIII. Authorized Official

Name: MR. STEVE VELZEN-HANER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 616-954-1547