Healthcare Provider Details

I. General information

NPI: 1376408948
Provider Name (Legal Business Name): PASADENA VILLA MICHIGAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39500 HIGH POINTE BLVD STE 490
NOVI MI
48375-5505
US

IV. Provider business mailing address

720 COOL SPRINGS BLVD STE 550
FRANKLIN TN
37067-2645
US

V. Phone/Fax

Practice location:
  • Phone: 248-826-5876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RUSH BRADY
Title or Position: CFO
Credential:
Phone: 615-260-2641