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General NPI Number Information
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NPI Number | 1902997224
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Entity Type | Organization
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Legal Business Name | WEDGWOOD CHRISTIAN SERVICES
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 3300 36TH ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49512-2810
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Country | US
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Telephone | 616-942-2110
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Fax | 616-942-0589
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Provider Business Mailing Address
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Address Line | 3300 36TH ST SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49512-2810
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Country | US
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Telephone | 616-942-2110
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Fax | 616-942-0589
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DANIEL T GOWDY
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Credential | ED D, CFRE
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Telephone | 616-942-2110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | CI410201226
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | CI410201359
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | CI410201082
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | CICI410201003
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | CI410201501
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License Number State | MI
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Taxonomy #7
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number | CI410201502
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License Number State | MI
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Taxonomy #8
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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