Healthcare Provider Details

I. General information

NPI: 1548394331
Provider Name (Legal Business Name): OPERATION GET DOWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 HARPER AVE
DETROIT MI
48213-3112
US

IV. Provider business mailing address

10100 HARPER AVE
DETROIT MI
48213-3112
US

V. Phone/Fax

Practice location:
  • Phone: 313-921-9422
  • Fax: 313-571-9022
Mailing address:
  • Phone: 313-921-9422
  • Fax: 313-571-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number822054
License Number StateMI

VIII. Authorized Official

Name: MR. EDWYNN BELL
Title or Position: PROGRAM DIRECTOR
Credential: M.A.,B.A. CAC. CCJP
Phone: 313-921-9422