Healthcare Provider Details

I. General information

NPI: 1609809474
Provider Name (Legal Business Name): CHILDREN'S ASSESSMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MICHIGAN ST NE
GRAND RAPIDS MI
49503-3525
US

IV. Provider business mailing address

901 MICHIGAN ST NE
GRAND RAPIDS MI
49503-3525
US

V. Phone/Fax

Practice location:
  • Phone: 616-336-5160
  • Fax: 616-336-5193
Mailing address:
  • Phone: 616-336-5160
  • Fax: 616-336-5193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: CRISTINA BUENTELLO
Title or Position: OFFICE MANAGER
Credential:
Phone: 616-336-5160