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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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
2322D00000XEmotionally Disturbed Childrens' Residential Treatment FacilityCI410201226MI
3322D00000XEmotionally Disturbed Childrens' Residential Treatment FacilityCI410201359MI
4322D00000XEmotionally Disturbed Childrens' Residential Treatment FacilityCI410201082MI
5322D00000XEmotionally Disturbed Childrens' Residential Treatment FacilityCICI410201003MI
6322D00000XEmotionally Disturbed Childrens' Residential Treatment FacilityCI410201501MI
73245S0500XChildren's Substance Abuse Rehabilitation FacilityCI410201502MI
8261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1902997224
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/PRESIDENT
Name : DANIEL T GOWDY
Credential : ED D, CFRE
Telephone Number : 616-942-2110
Provider Enumeration Date : 09/28/2006
Last Update Date : 11/04/2024

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:
1215047667 — 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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