Healthcare Provider Details

I. General information

NPI: 1578964656
Provider Name (Legal Business Name): IN THE VALLEY ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17581 JAMES COUZENS FWY
DETROIT MI
48235-2643
US

IV. Provider business mailing address

17581 JAMES COUZENS FWY
DETROIT MI
48235-2643
US

V. Phone/Fax

Practice location:
  • Phone: 586-217-8592
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State

VIII. Authorized Official

Name: TIYA CALVERT
Title or Position: OWNER
Credential:
Phone: 586-217-8592