Healthcare Provider Details

I. General information

NPI: 1912055872
Provider Name (Legal Business Name): CATHERINE'S HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 LAFAYETTE AVE NE
GRAND RAPIDS MI
49505-5092
US

IV. Provider business mailing address

1211 LAFAYETTE AVE NE
GRAND RAPIDS MI
49505-5092
US

V. Phone/Fax

Practice location:
  • Phone: 616-336-8800
  • Fax: 616-336-9700
Mailing address:
  • Phone: 616-336-8800
  • Fax: 616-336-9700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN A WALEN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 616-336-8800