Healthcare Provider Details

I. General information

NPI: 1760390009
Provider Name (Legal Business Name): CENTRIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4130 ALTER RD
DETROIT MI
48215-2349
US

IV. Provider business mailing address

4130 ALTER RD
DETROIT MI
48215-2349
US

V. Phone/Fax

Practice location:
  • Phone: 313-753-6385
  • Fax:
Mailing address:
  • Phone: 313-753-6385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State

VIII. Authorized Official

Name: MS. KIAH FARLEY
Title or Position: LPN NURSE
Credential: LPN NURSE
Phone: 313-753-6385