Provider Demographics
NPI:1609809474
Name:CHILDREN'S ASSESSMENT CENTER
Entity Type:Organization
Organization Name:CHILDREN'S ASSESSMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUENTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-336-5160
Mailing Address - Street 1:901 MICHIGAN ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3525
Mailing Address - Country:US
Mailing Address - Phone:616-336-5160
Mailing Address - Fax:616-336-5193
Practice Address - Street 1:901 MICHIGAN ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3525
Practice Address - Country:US
Practice Address - Phone:616-336-5160
Practice Address - Fax:616-336-5193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty