Healthcare Provider Details

I. General information

NPI: 1134389422
Provider Name (Legal Business Name): DETROIT RECOVERY PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 GLENDALE ST
HIGHLAND PARK MI
48203-3231
US

IV. Provider business mailing address

211 GLENDALE ST
HIGHLAND PARK MI
48203-3231
US

V. Phone/Fax

Practice location:
  • Phone: 313-868-0721
  • Fax: 313-868-0306
Mailing address:
  • Phone: 313-868-0721
  • Fax: 313-868-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. FRED WILLIAMS
Title or Position: CLINICAL DIRECTOR
Credential: LMSW
Phone: 313-868-0721