Provider Demographics
NPI:1518973858
Name:NORTH KENT GUIDANCE SERVICES LLC
Entity Type:Organization
Organization Name:NORTH KENT GUIDANCE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SKILLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-361-5001
Mailing Address - Street 1:5250 NORTHLAND DRIVE
Mailing Address - Street 2:SUITE A NORTH KENT GUIDANCE SERVICES LLC
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1040
Mailing Address - Country:US
Mailing Address - Phone:616-361-5001
Mailing Address - Fax:616-361-2166
Practice Address - Street 1:5250 NORTHLAND DRIVE
Practice Address - Street 2:SUITE A NORTH KENT GUIDANCE SERVICES LLC
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1040
Practice Address - Country:US
Practice Address - Phone:616-361-5001
Practice Address - Fax:616-361-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION83600004Medicare PIN
ON83600Medicare ID - Type Unspecified