Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Mark Frederic Peterson I

Individual provider Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · NPI 1841474012

Mr. Mark Frederic Peterson I is an Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Grand Rapids, Michigan. Practices as a sole proprietor. Licensed in Michigan.

Licensed in
MI
In the registry since
2007

Practice location Address checks out

3351 36th St
Grand Rapids, MI 49331
Phone: (616) 831-5659
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (primary) Taxonomy 320900000X · Licence 6802071051 (MI)

Record details

NPI number1841474012
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedDecember 24, 2007
Last updated in NPPESDecember 24, 2007
Mailing address2285 Christine Ct Se, Grand Rapids, MI 49546

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