Healthcare Provider Details

I. General information

NPI: 1306246111
Provider Name (Legal Business Name): DTFINANCIAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 N ARDMORE ST
PONTIAC MI
48342-2703
US

IV. Provider business mailing address

9625 RANSOM HILLS TER
NORTH CHESTERFIELD VA
23237-3470
US

V. Phone/Fax

Practice location:
  • Phone: 248-481-6614
  • Fax:
Mailing address:
  • Phone: 804-647-7416
  • Fax: 413-375-3839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAS630312744
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberAS630312744
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License NumberAS630312744
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberAS630312744
License Number StateMI

VIII. Authorized Official

Name: DANNY THOMPSON
Title or Position: OWNER
Credential:
Phone: 804-647-7416