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Pine Rest Christian Mental Health Services

Organization Active NPI Psychiatry Physician · Grand Rapids, MI

NPI 1174532147 · NPPES record last updated Jun 18, 2026

Key facts

NPI
1174532147
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatry Physician 2084P0800X
Legal business name
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Practice address
300 68TH St SE
Grand Rapids, MI 49548-6927
Phone
(616) 455-5000
NPI assigned
Aug 7, 2006
Organization subpart
Yes
Parent organization (as reported)
PINE REST CHRISTIAN MENTAL HEALTH SERVICES

Authorized official

Name
Diane M Fennema
Title
Managed Care Administrator
Phone
(616) 281-6372

Corporate family (same tax ID) 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

National Provider Directory

Tax ID family
Pine Rest Chicago Area (42 organizations share this tax ID)
Part of
Pine Rest Chicago Area

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor
Group: 193200000X MULTI-SPECIALTY GROUP		 101Y00000X
Behavior Analyst
Group: 193200000X MULTI-SPECIALTY GROUP		 103K00000X
Psychologist
Group: 193200000X MULTI-SPECIALTY GROUP		 103T00000X
Social Worker
Group: 193200000X MULTI-SPECIALTY GROUP		 104100000X
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X
Pediatrics Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208000000X
Psychiatry Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2084P0800X Yes
General Practice Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208D00000X
Occupational Therapist
Group: 193200000X MULTI-SPECIALTY GROUP		 225X00000X
Speech-Language Pathologist
Group: 193200000X MULTI-SPECIALTY GROUP		 235Z00000X

Addresses

Primary practice location

300 68TH St SE
Grand Rapids, MI 49548-6927

Mailing address

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

Other identifiers

IdentifierTypeStateIssuer
350D148360OtherMIPEDIATRICS
P10D11275OtherMIPSYCHOLOGISTS-MA, DOCTORA
260D17625OtherMIPSYCHIATRISTS
680D16189OtherMIPSYCHOLOGISTS
70D16083OtherMIMULTISPECIALTY
110D148370OtherMIINTERNAL MD
500D11133OtherMINURSE PRACTICIONERS

Electronic endpoints

TypeEndpointUseAffiliation
Direct Messaging Address pinerestCMHS@directaddress.pinerest.org Direct

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 18, 2026.

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781740800000",
    "number": "1174532147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE REST CHRISTIAN MENTAL HEALTH SERVICES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PINE REST CHRISTIAN MENTAL HEALTH SERVICES",
        "enumeration_date": "2006-08-07",
        "last_updated": "2026-06-18",
        "certification_date": "2026-06-18",
        "status": "A",
        "authorized_official_last_name": "FENNEMA",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGED CARE ADMINISTRATOR",
        "authorized_official_telephone_number": "616-281-6372"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEDIATRICS",
            "identifier": "350D148360",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGISTS-MA, DOCTORA",
            "identifier": "P10D11275",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHIATRISTS",
            "identifier": "260D17625",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PSYCHOLOGISTS",
            "identifier": "680D16189",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTISPECIALTY",
            "identifier": "70D16083",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNAL MD",
            "identifier": "110D148370",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTICIONERS",
            "identifier": "500D11133",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pinerestCMHS@directaddress.pinerest.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "300 68th St SE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495486927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MI

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Sources for this page

Verify at the official NPI Registry.