Kent County Cmh Authority
Specialty details in registry · Grand Rapids, MI
At a glance
790 Fuller Ave Ne, Grand Rapids, MI 49503-1918
NPPES record updated Oct 23, 2025. Public records can lag behind changes at a practice.
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Insurance participation and appointment availability are not established by these public records.
Practice location
790 Fuller Ave NeGrand Rapids, MI 49503-1918
Additional reported practice locations
260 Jefferson Ave SeGrand Rapids, MI 495034597
Phone: 6163363909
Fax: 6163368830
Professional details: NPI, taxonomy & registry record
Registry details
- Primary taxonomy
- Specialty details in registry
- Taxonomy code
- 251S00000X
- Enumeration date
- Jul 17, 2025
- Record updated
- Oct 23, 2025
More registry details
- Provider type
- Organization · Type 2
- Other reported name
- <UNAVAIL>
Reported taxonomies and licenses
Specialty details in registry
251S00000X · Primary
License numbers and credentials are reported to NPPES; HCPList does not independently verify them.
Practice location
790 Fuller Ave NeGrand Rapids, MI 49503-1918
- Phone
- (616) 336-3909
- Fax
- (616) 336-8830
Mailing address
790 FULLER AVE NEGRAND RAPIDS, MI 495031918
Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.
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