Healthcare Provider Details

I. General information

NPI: 1770538068
Provider Name (Legal Business Name): CNS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24230 KARIM BLVD SUITE 100
NOVI MI
48375-2960
US

IV. Provider business mailing address

24230 KARIM BLVD SUITE 100
NOVI MI
48375-2960
US

V. Phone/Fax

Practice location:
  • Phone: 248-745-4900
  • Fax: 248-994-8005
Mailing address:
  • Phone: 248-745-4900
  • Fax: 248-994-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. JEROME BAMMELL
Title or Position: VP OF FINANCE
Credential: CPA, CGMA
Phone: 248-871-1404