NPIMap

Organization Active NPI

Family Outreach Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Grand Rapids, MI
National Provider Identifier
1619980927
Registry record updated Mar 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
FAMILY OUTREACH CENTER
Practice address
1939 S Division
Grand Rapids, MI 49507
Phone
(616) 247-3815
Fax
(616) 245-0450
NPI assigned
Aug 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Veneese ChandlerNPI 1306964952
Title
Executive Director
Phone
(616) 247-3815

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

1939 S Division
Grand Rapids, MI 49507

Mailing address

1939 S Division
Grand Rapids, MI 49507
Phone (616) 247-3815

Other identifiers 2

IdentifierTypeStateIssuer
0D16322OtherMIMEDICARE ID
4483587MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040211000799 MI Part B Supplier - Clinic/Group Practice 0446144331 Receives reassigned benefits from 2 practitioners
Practice locations: Grand Rapids, MI
O20040518001114 MI Part B Supplier - Clinic/Group Practice 0446144331 Receives reassigned benefits from 1 practitioner
Practice locations: Grand Rapids, MI

National Provider Directory

National Provider Directory
Tax ID family
Family Outreach Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

255 Colrain St SW
Ste 2
Wyoming, MI 49548
Phone (616) 988-1479

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520467200000",
    "number": "1619980927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1939 S DIVISION",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49507",
            "telephone_number": "616-247-3815",
            "fax_number": "616-245-0450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1939 S DIVISION",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49507",
            "telephone_number": "616-247-3815",
            "fax_number": "616-245-0450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY OUTREACH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-15",
        "last_updated": "2018-03-08",
        "status": "A",
        "authorized_official_last_name": "CHANDLER",
        "authorized_official_first_name": "VENEESE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "616-247-3815"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "0D16322",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4483587",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.