Healthcare Provider Details

I. General information

NPI: 1740480078
Provider Name (Legal Business Name): PATIENT SUPPORT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28050 JOHN R RD
MADISON HTS MI
48071-2812
US

IV. Provider business mailing address

28050 JOHN R RD
MADISON HTS MI
48071-2812
US

V. Phone/Fax

Practice location:
  • Phone: 248-591-9500
  • Fax:
Mailing address:
  • Phone: 248-591-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD DICICCO
Title or Position: CEO
Credential:
Phone: 248-591-9500