Healthcare Provider Details

I. General information

NPI: 1861787913
Provider Name (Legal Business Name): PRATT'S PLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 EVERGREEN AVE
DETROIT MI
48228-2940
US

IV. Provider business mailing address

28290 TAVISTOCK TRL
SOUTHFIELD MI
48034-5181
US

V. Phone/Fax

Practice location:
  • Phone: 313-655-5921
  • Fax:
Mailing address:
  • Phone: 313-655-5921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAS820308702
License Number StateMI

VIII. Authorized Official

Name: MS. JUNE VISTA-MARIA PRATT
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 313-655-5921