Healthcare Provider Details

I. General information

NPI: 1215799978
Provider Name (Legal Business Name): SENIOR THERAPEUTIC SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 WALLI STRASSE DR STE B
BURTON MI
48509-1729
US

IV. Provider business mailing address

4001 WALLI STRASSE DR STE B
BURTON MI
48509-1729
US

V. Phone/Fax

Practice location:
  • Phone: 810-306-2858
  • Fax:
Mailing address:
  • Phone: 810-306-2858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: NICK RIVETTE
Title or Position: OWNER
Credential:
Phone: 989-293-4621