Healthcare Provider Details

I. General information

NPI: 1447619697
Provider Name (Legal Business Name): GREAT SCOTT HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 LESLIE ST DETROIT
DETROIT MI
48238-3308
US

IV. Provider business mailing address

PO BOX 4207
SOUTHFIELD MI
48037-4207
US

V. Phone/Fax

Practice location:
  • Phone: 248-910-9560
  • Fax: 248-799-9210
Mailing address:
  • Phone: 248-910-9560
  • Fax: 248-799-9210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberAF820307845
License Number StateMI

VIII. Authorized Official

Name: MRS. NEDESTA NWABUEZE
Title or Position: PRESIDENT
Credential:
Phone: 248-910-9560