Healthcare Provider Details

I. General information

NPI: 1962941518
Provider Name (Legal Business Name): CHRISTIAN HEALTHCARE CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 E BELTLINE CT NE
GRAND RAPIDS MI
49525-9480
US

IV. Provider business mailing address

PO BOX 151190
GRAND RAPIDS MI
49515-1190
US

V. Phone/Fax

Practice location:
  • Phone: 616-226-2669
  • Fax:
Mailing address:
  • Phone: 616-226-2669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301030071
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1419845
License Number StateMI

VIII. Authorized Official

Name: MARK BRIAN BLOCHER
Title or Position: PRESIDENT/CEO
Credential:
Phone: 616-340-7079