Healthcare Provider Details

I. General information

NPI: 1083786669
Provider Name (Legal Business Name): COMMON GROUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N TELEGRAPH RD BLDG 32 EAST
PONTIAC MI
48341-1032
US

IV. Provider business mailing address

1200 N TELEGRAPH RD BLDG 32 EAST
PONTIAC MI
48341-1032
US

V. Phone/Fax

Practice location:
  • Phone: 248-541-3522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. TONY ROTHSCHILD
Title or Position: CEO
Credential:
Phone: 248-456-8150