Healthcare Provider Details

I. General information

NPI: 1316132459
Provider Name (Legal Business Name): EVEREST INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19510 CASCADE DR
BROWNSTOWN MI
48193-8572
US

IV. Provider business mailing address

PO BOX 2352
RIVERVIEW MI
48193-1352
US

V. Phone/Fax

Practice location:
  • Phone: 734-675-3037
  • Fax: 734-675-3332
Mailing address:
  • Phone: 734-675-3037
  • Fax: 734-675-3332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. LOUISE A SEMETKO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 734-675-3037