Healthcare Provider Details

I. General information

NPI: 1679663546
Provider Name (Legal Business Name): ALL WELL-BEING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 FIELD ST
DETROIT MI
48214
US

IV. Provider business mailing address

1423 FIELD ST
DETROIT MI
48214-2321
US

V. Phone/Fax

Practice location:
  • Phone: 313-924-7860
  • Fax: 313-924-0350
Mailing address:
  • Phone: 313-924-7860
  • Fax: 313-924-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DAWN RUCKER
Title or Position: PRESIDENT & CEO
Credential: LMSW
Phone: 313-924-7860