Healthcare Provider Details

I. General information

NPI: 1083583942
Provider Name (Legal Business Name): NRST DETROIT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17950 WOODWARD AVE
DETROIT MI
48203-2260
US

IV. Provider business mailing address

17950 WOODWARD AVE
DETROIT MI
48203-2260
US

V. Phone/Fax

Practice location:
  • Phone: 916-753-5762
  • Fax: 916-536-6416
Mailing address:
  • Phone: 916-753-5762
  • Fax: 916-536-6416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIAN SCALLEN
Title or Position: CMO
Credential: MD
Phone: 916-753-5762