NPIMap

Organization Active NPI

The Shoreline Center LLC

  • Clinical Psychologist
  • Grand Haven, MI
National Provider Identifier
1942689708
Registry record updated Aug 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301014390 Issued in MI
Legal business name
THE SHORELINE CENTER LLC
Practice address
16925 Ability Way
Grand Haven, MI 49417-9325
Phone
(616) 935-7606
Fax
(616) 935-7607
NPI assigned
May 27, 2015
Last updated
Aug 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2021

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

Authorized official

Name
Dan Radley
Title
Owner
Phone
(616) 935-7606

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X NU
Clinical Psychologist 103TC0700X 6301014390 MI Primary

Addresses

Primary practice location

16925 Ability Way
Grand Haven, MI 49417-9325

Mailing address

16925 Ability Way
Grand Haven, MI 49417-9325
Phone (616) 935-7606

Other practice location 1

16930 Robbins Rd
Suite 120
Grand Haven, MI 49417-2787
Phone (616) 935-0747

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160218000349 MI Part B Supplier - Clinic/Group Practice 5294030938 Receives reassigned benefits from 2 practitioners
Practice locations: Grand Haven, MI

National Provider Directory

National Provider Directory

Locations

16925 Ability Way
Grand Haven, MI 49417
Phone (616) 268-2074

16930 Robbins Rd
Ste 120
Grand Haven, MI 49417
Phone (616) 935-0747

Practitioners & affiliated clinicians

Practitioners 81

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 81

NPI Registry JSON

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

{
    "created_epoch": "1432684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627948800000",
    "number": "1942689708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16925 ABILITY WAY",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494179325",
            "telephone_number": "616-935-7606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16925 ABILITY WAY",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494179325",
            "telephone_number": "616-935-7606",
            "fax_number": "616-935-7607"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16930 Robbins Rd",
            "address_2": "Suite 120",
            "address_purpose": "LOCATION",
            "city": "Grand Haven",
            "state": "MI",
            "postal_code": "494172787",
            "country_code": "US",
            "telephone_number": "616-935-0747",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE SHORELINE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-27",
        "last_updated": "2021-08-03",
        "certification_date": "2021-08-03",
        "status": "A",
        "authorized_official_last_name": "RADLEY",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-935-7606"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301014390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Haven, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2021; 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.