Healthcare Provider Details

I. General information

NPI: 1467853754
Provider Name (Legal Business Name): SOMEWHERE TO GO SOMETHING TO DO ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2014
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17600 W 11 MILE RD SUITE 100
LATHRUP VILLAGE MI
48076-4722
US

IV. Provider business mailing address

17600 W 11 MILE RD SUITE 100
LATHRUP VILLAGE MI
48076-4722
US

V. Phone/Fax

Practice location:
  • Phone: 248-327-7046
  • Fax:
Mailing address:
  • Phone: 248-327-7046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6801085319
License Number StateMI

VIII. Authorized Official

Name: MR. RONALD EDWARD MASSEY
Title or Position: PRESIDENT
Credential:
Phone: 586-698-9050