Basic Information
| Provider Information | |||||||||
| NPI: | 1679200208 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PENNOCK HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MICHIGAN NE ST MC845 | ||||||||
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| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495032560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164866790 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3885 BENDER RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493339273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2697954434 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2022 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| AuthorizedOfficialLastName: | CATIGNANI | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 9475220008 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.