Healthcare Provider Details

I. General information

NPI: 1376526616
Provider Name (Legal Business Name): EASTERSEALS MORC HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2399 E WALTON BLVD
AUBURN HILLS MI
48326-1955
US

IV. Provider business mailing address

2399 E WALTON BLVD
AUBURN HILLS MI
48326-1955
US

V. Phone/Fax

Practice location:
  • Phone: 248-475-6400
  • Fax: 248-475-6402
Mailing address:
  • Phone: 248-475-6400
  • Fax: 248-475-6402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: BRENT WIRTH
Title or Position: PRESIDENT & CEO
Credential:
Phone: 248-475-6300