MEDICARE: LONDON ASBURY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669188025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONDON ASBURY

Provider Business Mailing Address
First Line	:	17323 WILDEMERE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-2722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18983 HAMBURG ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-2146
Country	:	US
Telephone Number	:	517-275-2704
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2023
Last Update Date	:	01/27/2023

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Directions to “ LONDON ASBURY ” Practice Location

Language	Start Address	Practice Location

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