MEDICARE: CENTRIA HEALTHCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1578386462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRIA HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	27777 INKSTER RD STE 100
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-5312
Country	:	US
Telephone Number	:	855-772-8847
Fax Number	:	248-598-4966

Provider Business Practice Location Address
First Line	:	6820 HOSPITAL DR STE 100
Second Line	:
City	:	ROSEDALE
State	:	MD
Zip	:	21237-4358
Country	:	US
Telephone Number	:	855-772-8847
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF CONTRACT ADMINISTRATION
Name	:	MR. DANIEL CORLEY
Credential	:
Telephone Number	:	248-919-1156

Provider Enumeration Date	:	11/07/2024
Last Update Date	:	01/23/2026

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