Healthcare Provider Details

I. General information

NPI: 1992728331
Provider Name (Legal Business Name): SCOTT CORRECTIONL FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47500 FIVE MILE RD
PLYMOUTH MI
48170-2487
US

IV. Provider business mailing address

3425 CHEROKEE TRL
YPSILANTI MI
48198-9498
US

V. Phone/Fax

Practice location:
  • Phone: 734-459-7400
  • Fax:
Mailing address:
  • Phone: 734-481-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number4301059562
License Number StateMI

VIII. Authorized Official

Name: DR. ARUNA BAVINENI
Title or Position: STAFF PSYCHIATRIST
Credential: MD
Phone: 734-459-7400