| The Shoreline Center Llc | |
|
16925 Ability Way Grand Haven MI 49417-9325 | |
| (616) 935-7606 | |
| (616) 935-7607 |
| Full Name | The Shoreline Center Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 16925 Ability Way, Grand Haven, Michigan |
| Authorized Official Name and Position | Dan Radley (OWNER) |
| Authorized Official Contact | 6169357606 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Shoreline Center Llc 16925 Ability Way Grand Haven MI 49417-9325 Ph: (616) 935-7606 | The Shoreline Center Llc 16925 Ability Way Grand Haven MI 49417-9325 Ph: (616) 935-7606 |
| NPI Number | 1942689708 |
|---|---|
| Provider Enumeration Date | 05/27/2015 |
| Last Update Date | 08/03/2021 |
| Certification Date | 08/03/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942689708 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 6301014390 (Michigan) | Primary |
| 261QD1600X | Clinic/center - Developmental Disabilities | (* (Not Available)) | Secondary |
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