Healthcare Provider Details

I. General information

NPI: 1538949797
Provider Name (Legal Business Name): R&R PEACEFUL SURROUNDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13560 E MCNICHOLS RD
DETROIT MI
48205-3426
US

IV. Provider business mailing address

P.O BOX 13185
DETROIT MI
48213
US

V. Phone/Fax

Practice location:
  • Phone: 313-729-4547
  • Fax:
Mailing address:
  • Phone: 586-243-5776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: REGINA HARPER
Title or Position: CEO
Credential:
Phone: 586-243-5776