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NPI Code Detail

MEDICARE: WEDGWOOD CHRISTIAN SERVICES

MEDICARE: WEDGWOOD CHRISTIAN SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health AgencyMI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215047667
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEDGWOOD CHRISTIAN SERVICES
Provider Business Mailing Address
First Line : 3300 36TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-2810
Country : US
Telephone Number : 616-942-2110
Fax Number : 616-942-0589
Provider Business Practice Location Address
First Line : 3300 36TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-2810
Country : US
Telephone Number : 616-942-2110
Fax Number : 616-942-0589
Authorized Official
Title or Position : CEO
Name : DR. DANIEL T GOWDY
Credential :
Telephone Number : 616-942-2110
Provider Enumeration Date : 08/30/2006
Last Update Date : 11/02/2023

Similar Medicare Providers

1649218041 — MARION OAKES-HUNTER LLPC, CADC
Practice Location Address:
3300 36TH ST SE
GRAND RAPIDS, MI
49512-2810
Practice Phone: 616-942-2110
Practice Fax:
1902997224 — WEDGWOOD CHRISTIAN SERVICES
Practice Location Address:
3300 36TH ST SE
GRAND RAPIDS, MI
49512-2810
Practice Phone: 616-942-2110
Practice Fax: 616-942-0589
1750414827 — WEDGWOOD CHRISTAIN SERVICES
Practice Location Address:
3300 36TH ST SE
GRAND RAPIDS, MI
49512-2810
Practice Phone: 616-559-5835
Practice Fax: 616-281-6448
1386842516 — MRS. JANELL ELAINE PRINS LLMSW
Practice Location Address:
3300 36TH ST SE
GRAND RAPIDS, MI
49512-2810
Practice Phone: 616-559-5878
Practice Fax:
1396939054 — DR. ELIZABETH RAESE PSY.D.
Practice Location Address:
3300 36TH ST SE
GRAND RAPIDS, MI
49512-2810
Practice Phone: 616-831-5649
Practice Fax: 616-942-9548
1740462076 — MS. AMY MICHELLE LAMBERT LLMSW
Practice Location Address:
3300 36TH ST SE
GRAND RAPIDS, MI
49512-2810
Practice Phone: 616-942-2110
Practice Fax:

Directions to “WEDGWOOD CHRISTIAN SERVICES ” Practice Location

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