Healthcare Provider Details

I. General information

NPI: 1295628394
Provider Name (Legal Business Name): CLD GYM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 VARSITY DR STE A
ANN ARBOR MI
48108-2359
US

IV. Provider business mailing address

4370 VARSITY DR STE A
ANN ARBOR MI
48108-2359
US

V. Phone/Fax

Practice location:
  • Phone: 734-623-9422
  • Fax:
Mailing address:
  • Phone: 734-623-9422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBIN NICOLE HALL
Title or Position: OWNER
Credential:
Phone: 734-368-8879