Healthcare Provider Details

I. General information

NPI: 1801154943
Provider Name (Legal Business Name): PETER RABBIT DAY CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 CADIEUX RD
DETROIT MI
48224-2003
US

IV. Provider business mailing address

5901 CADIEUX RD
DETROIT MI
48224-2003
US

V. Phone/Fax

Practice location:
  • Phone: 313-882-7446
  • Fax:
Mailing address:
  • Phone: 313-882-7446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number8200017384
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: BERNITA HAVARD
Title or Position: DIRECTOR
Credential:
Phone: 313-882-7446