Provider Demographics
NPI:1710638960
Name:PSYCHIATRY SPECIALISTS OF GRAND RAPIDS, PLLC
Entity Type:Organization
Organization Name:PSYCHIATRY SPECIALISTS OF GRAND RAPIDS, PLLC
Other - Org Name:THRIVE CENTER FOR HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KREGER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:616-805-3350
Mailing Address - Street 1:847 PARCHMENT DR SE STE 15
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2303
Mailing Address - Country:US
Mailing Address - Phone:616-805-3350
Mailing Address - Fax:
Practice Address - Street 1:847 PARCHMENT DR SE STE 15
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2303
Practice Address - Country:US
Practice Address - Phone:616-805-3350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301062800OtherPSYCHIATRY
MI4704203886OtherCRNA