MR. MARK FREDERIC PETERSON I
NPI 1841474012
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Grand Rapids, MI

Q: What is Mark Peterson's NPI number?

The NPI number for Mark Peterson is 1841474012. It was assigned to this individual provider in the NPPES registry on December 24, 2007.

Q: What is Mark Peterson's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

Q: When was this NPI record last updated?

The NPPES record for Mark Peterson was last updated on December 24, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since December 24, 2007

3351 36TH ST, GRAND RAPIDS, MI 49331(616) 831-5659 Get Directions Write a Review

NPPES record last updated: December 24, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Mr. Mark Frederic Peterson I NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. MARK FREDERIC PETERSON I (NPI 1841474012) is an individual community based residential treatment facility, intellectual and/or developmental disabilities provider in Grand Rapids, Michigan, licensed in Michigan (6802071051) and active in the NPI registry since December 2007.

NPPES Registry Identity

NPI1841474012

Entity TypeIndividualMale

Primary Taxonomy320900000X

Provider Legal NameMR. MARK FREDERIC PETERSON I

Location Address3351 36TH STGrand Rapids, MI 49331

Mailing Address2285 Christine Ct SeGrand Rapids, MI 49546 · (616) 831-5659

Phone(616) 831-5659

Sole ProprietorYes

Enumeration DateDecember 24, 2007

✔ NPI 1841474012 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities

Taxonomy Code320900000X

License✔ Licensed in MI · 6802071051

Definition

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.

3351 36TH ST, Grand Rapids, MI 49331

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark Peterson's NPI number?

The NPI number for Mark Peterson is 1841474012. It was assigned to this individual provider in the NPPES registry on December 24, 2007.

Where is Mark Peterson located?

Mark Peterson practices at 3351 36th St, Grand Rapids, MI 49331. The listed phone number is (616) 831-5659.

What is Mark Peterson's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

When was this NPI record last updated?

The NPPES record for Mark Peterson was last updated on December 24, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.