Healthcare Provider Details

I. General information

NPI: 1285627513
Provider Name (Legal Business Name): CARE OF SOUTHEASTERN MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31900 UTICA RD.
FRASER MI
48026
US

IV. Provider business mailing address

31900 UTICA RD.
FRASER MI
48026
US

V. Phone/Fax

Practice location:
  • Phone: 586-541-0033
  • Fax: 586-541-0034
Mailing address:
  • Phone: 586-541-0033
  • Fax: 586-541-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberSA0500016
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN STYF
Title or Position: PRESIDENT & CEO
Credential: LMSW
Phone: 586-541-2273