Healthcare Provider Details

I. General information

NPI: 1548501349
Provider Name (Legal Business Name): FAMILY OUTREACH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 DIVISION AVE S
GRAND RAPIDS MI
49507-2480
US

IV. Provider business mailing address

1939 DIVISION AVE S
GRAND RAPIDS MI
49507-2480
US

V. Phone/Fax

Practice location:
  • Phone: 616-247-3815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6801095127
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: VENEESE CHANDLER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 616-247-3815