Healthcare Provider Details

I. General information

NPI: 1851457451
Provider Name (Legal Business Name): SELF HELP ADDICTION REHABILITATION (SHAR)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1852 W GRAND BLVD
DETROIT MI
48208-1006
US

IV. Provider business mailing address

1852 W GRAND BLVD
DETROIT MI
48208-1006
US

V. Phone/Fax

Practice location:
  • Phone: 313-894-8444
  • Fax: 313-894-2712
Mailing address:
  • Phone: 313-894-8444
  • Fax: 313-894-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number820704
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number820174
License Number StateMI

VIII. Authorized Official

Name: CURTIS JENNINGS
Title or Position: INTERIM CEO
Credential:
Phone: 13138942410