Healthcare Provider Details

I. General information

NPI: 1033698477
Provider Name (Legal Business Name): CASON ADULT DAY PROGRAM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 ROLYAT ST
DETROIT MI
48234-3358
US

IV. Provider business mailing address

24865 5 MILE RD STE 2
REDFORD MI
48239-3694
US

V. Phone/Fax

Practice location:
  • Phone: 248-721-5164
  • Fax: 313-255-2101
Mailing address:
  • Phone: 248-721-5164
  • Fax: 313-255-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIANA ONYEGBADO
Title or Position: OPERATION MANAGER
Credential:
Phone: 313-826-1430