Provider Demographics
NPI:1699358655
Name:CALVIN CHRISTIAN REFORMED CHURCH
Entity Type:Organization
Organization Name:CALVIN CHRISTIAN REFORMED CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOELMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-417-6281
Mailing Address - Street 1:400 N CALVIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-1928
Mailing Address - Country:US
Mailing Address - Phone:810-417-6281
Mailing Address - Fax:
Practice Address - Street 1:387 W LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-1912
Practice Address - Country:US
Practice Address - Phone:810-417-6281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401019213Medicaid