Healthcare Provider Details

I. General information

NPI: 1477701738
Provider Name (Legal Business Name): FAY MARIE BRETZ ASSOCIATES DEGREE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 08/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29626 ERIE CT
CHESTERFIELD MI
48051-2242
US

IV. Provider business mailing address

29626 ERIE CT
CHESTERFIELD MI
48051-2242
US

V. Phone/Fax

Practice location:
  • Phone: 586-420-0807
  • Fax:
Mailing address:
  • Phone: 586-420-0807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: