Healthcare Provider Details

I. General information

NPI: 1447090014
Provider Name (Legal Business Name): OUR NEIGHBORHOOD ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3096 12 MILE RD
BERKLEY MI
48072-1302
US

IV. Provider business mailing address

3096 12 MILE RD
BERKLEY MI
48072-1302
US

V. Phone/Fax

Practice location:
  • Phone: 248-556-5332
  • Fax:
Mailing address:
  • Phone: 248-556-5332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. ALLISON E GREENE
Title or Position: FOUNDER, DIRECTOR
Credential: TEACHER
Phone: 248-930-9959