Healthcare Provider Details

I. General information

NPI: 1013537802
Provider Name (Legal Business Name): GRETCHEN'S PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OWEN ST
BELLEVILLE MI
48111-2921
US

IV. Provider business mailing address

46036 MICHIGAN AVE # 318
CANTON MI
48188-2304
US

V. Phone/Fax

Practice location:
  • Phone: 734-699-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEODGE HILL
Title or Position: OWNER
Credential: PA
Phone: 734-699-5400