Healthcare Provider Details

I. General information

NPI: 1306098801
Provider Name (Legal Business Name): PREMIER SERVICES OF MICHIGAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 02/10/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E 12 MILE RD
MADISON HEIGHTS MI
48071-2651
US

IV. Provider business mailing address

PO BOX 220
SULLIVAN MO
63080-0220
US

V. Phone/Fax

Practice location:
  • Phone: 248-547-2223
  • Fax: 800-377-9518
Mailing address:
  • Phone: 573-860-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: CINDY GAITHER
Title or Position: VP REVENUE CYCLE MGMT
Credential:
Phone: 602-248-8886