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Mr. Mark Frederic Peterson I
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Grand Rapids, Michigan
NPI 1841474012

Mark Frederic Peterson I is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Grand Rapids, MI. Mark Frederic Peterson I practices in Grand Rapids, MI. The NPI Number for Mark Frederic Peterson I is 1841474012 and holds a License No. 6802071051 (Michigan).

The current practice location address for Mark Frederic Peterson I is 3351 36Th St, Grand Rapids, MI and can be reached out via phone at 616-831-5659.

Location: 3351 36Th St, Grand Rapids, MI, 49546
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1841474012
Provider Name
Mark Frederic Peterson I
Credential
Provider Entity Type
Individual
Gender
Male
Address
3351 36Th St, Grand Rapids, MI, 49546
Phone Number
616-831-5659
Fax Number
Provider Enumeration Date
12/24/2007
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
3351 36Th St
City
Grand Rapids
State
Michigan
Zip
49331
Phone Number
616-831-5659
Fax Number
person
Provider Business Mailing Address Details
Address
3351 36Th St
City
Grand Rapids
State
Michigan
Zip
49331
Phone Number
616-831-5659
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
6802071051 (Michigan)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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