Healthcare Provider Details

I. General information

NPI: 1215257415
Provider Name (Legal Business Name): PREMIER SERVICES OF MICHIGAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 02/10/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25639 FORD RD
DEARBORN HEIGHTS MI
48127-4817
US

IV. Provider business mailing address

25639 FORD RD
DEARBORN HEIGHTS MI
48127-4817
US

V. Phone/Fax

Practice location:
  • Phone: 313-277-3293
  • Fax: 313-532-2773
Mailing address:
  • Phone: 313-277-3293
  • Fax: 313-532-2773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CINDY GAITHER
Title or Position: VP REVENUE CYCLE MGMT
Credential:
Phone: 602-248-8886