Healthcare Provider Details

I. General information

NPI: 1053566398
Provider Name (Legal Business Name): VARIETY FAR CONSERVATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1669 W MAPLE RD
BIRMINGHAM MI
48009-1230
US

IV. Provider business mailing address

1669 W MAPLE RD
BIRMINGHAM MI
48009-1230
US

V. Phone/Fax

Practice location:
  • Phone: 248-646-3347
  • Fax: 480-247-5901
Mailing address:
  • Phone: 248-646-3347
  • Fax: 480-247-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ARLENE KASS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 248-646-3347