Provider Demographics
NPI:1477026847
Name:VETGR
Entity Type:Organization
Organization Name:VETGR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN
Authorized Official - Phone:616-226-6435
Mailing Address - Street 1:77 MONROE CENTER ST NW STE 504
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2903
Mailing Address - Country:US
Mailing Address - Phone:616-226-6435
Mailing Address - Fax:
Practice Address - Street 1:77 MONROE CENTER ST NW STE 504
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2903
Practice Address - Country:US
Practice Address - Phone:616-226-6435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)