Healthcare Provider Details

I. General information

NPI: 1568866937
Provider Name (Legal Business Name): BEGINNING OF INDEPENDENCE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 MACOMB PL SUITE 47
MOUNT CLEMENS MI
48043-5675
US

IV. Provider business mailing address

49 MACOMB PLACE SUITE 47
MT. CLEMENS MI
48043
US

V. Phone/Fax

Practice location:
  • Phone: 586-604-6766
  • Fax:
Mailing address:
  • Phone: 586-604-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ROY DEMELE BURTON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 586-604-6766