Provider Demographics
NPI:1104488949
Name:CHARIS
Entity type:Organization
Organization Name:CHARIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ANNISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOPS
Authorized Official - Suffix:
Authorized Official - Credentials:LLMSW
Authorized Official - Phone:616-745-5495
Mailing Address - Street 1:4350 COTTAGE TRL
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-6702
Mailing Address - Country:US
Mailing Address - Phone:616-745-5495
Mailing Address - Fax:
Practice Address - Street 1:186 S RIVER AVE STE 5
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-2848
Practice Address - Country:US
Practice Address - Phone:616-377-4899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1871044214OtherNPPES