Provider Demographics
NPI:1861045775
Name:RELIANCE COMMUNITY CARE PARTNERS
Entity Type:Organization
Organization Name:RELIANCE COMMUNITY CARE PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATHESONNORTHERN
Authorized Official - Suffix:
Authorized Official - Credentials:ABA
Authorized Official - Phone:616-954-1518
Mailing Address - Street 1:2100 RAYBROOK ST SE STE 203
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5783
Mailing Address - Country:US
Mailing Address - Phone:616-954-1518
Mailing Address - Fax:616-954-1520
Practice Address - Street 1:2100 RAYBROOK ST SE STE 100
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5782
Practice Address - Country:US
Practice Address - Phone:616-954-1555
Practice Address - Fax:616-954-1520
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELIANCE COMMUNITY CARE PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-19
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty