Provider Demographics
NPI:1912055872
Name:CATHERINE'S HEALTH CENTER
Entity Type:Organization
Organization Name:CATHERINE'S HEALTH CENTER
Other - Org Name:CATHERINE'S CARE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-336-8800
Mailing Address - Street 1:1211 LAFAYETTE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-5092
Mailing Address - Country:US
Mailing Address - Phone:616-336-8800
Mailing Address - Fax:616-336-9700
Practice Address - Street 1:1211 LAFAYETTE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5092
Practice Address - Country:US
Practice Address - Phone:616-336-8800
Practice Address - Fax:616-336-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1018352Medicaid