Healthcare Provider Details

I. General information

NPI: 1750803946
Provider Name (Legal Business Name): CARRIE ARNOLD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 07/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BILTMORE ST
INKSTER MI
48141-1387
US

IV. Provider business mailing address

PO BOX 85911
WESTLAND MI
48185-0911
US

V. Phone/Fax

Practice location:
  • Phone: 248-513-5123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GIOVANNI CHRISTOPHER JOHNSON
Title or Position: OWNER
Credential:
Phone: 248-513-5123