Healthcare Provider Details

I. General information

NPI: 1891015814
Provider Name (Legal Business Name): ONSITE SUBSTANCE ABUSE TESTING LLC - NEW FRONTIER COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22720 WOODWARD AVE STE 205
FERNDALE MI
48220-2906
US

IV. Provider business mailing address

22720 WOODWARD AVE STE 205
FERNDALE MI
48220-2906
US

V. Phone/Fax

Practice location:
  • Phone: 248-399-8032
  • Fax: 248-399-8042
Mailing address:
  • Phone: 248-399-8032
  • Fax: 248-399-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number500450
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number631332
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number823129
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number810364
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number810364
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number823129
License Number StateMI
# 7
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number631332
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number500450
License Number StateMI

VIII. Authorized Official

Name: MR. JACOB FAKHOURY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 248-399-8032