Healthcare Provider Details

I. General information

NPI: 1720268063
Provider Name (Legal Business Name): ROBBIE'S PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2007
Last Update Date: 11/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4038 TAYLOR ST
DETROIT MI
48204-2419
US

IV. Provider business mailing address

98 RHODE ISLAND ST
HIGHLAND PARK MI
48203-3359
US

V. Phone/Fax

Practice location:
  • Phone: 313-894-7350
  • Fax: 313-894-7350
Mailing address:
  • Phone: 313-883-4515
  • Fax: 313-664-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateMI

VIII. Authorized Official

Name: VERRITA RENEE FOUNTAIN
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 313-883-4515