Healthcare Provider Details

I. General information

NPI: 1801065909
Provider Name (Legal Business Name): POSITIVE IMAGES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13336 E WARREN AVE
DETROIT MI
48215-2112
US

IV. Provider business mailing address

13336 EAST WARREN
DETROIT MI
48215
US

V. Phone/Fax

Practice location:
  • Phone: 313-822-6940
  • Fax: 313-822-6940
Mailing address:
  • Phone: 313-822-6940
  • Fax: 313-822-6940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number822778
License Number StateMI

VIII. Authorized Official

Name: TIESHA HEMINGWAY
Title or Position: OFFICE ASSISTANT
Credential: FAODP
Phone: 313-822-6940