Healthcare Provider Details

I. General information

NPI: 1194360651
Provider Name (Legal Business Name): HEALTHCALL OF DETROIT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28000 WOODWARD AVE STE 100
ROYAL OAK MI
48067-0961
US

IV. Provider business mailing address

28000 WOODWARD AVE STE 100
ROYAL OAK MI
48067-0961
US

V. Phone/Fax

Practice location:
  • Phone: 248-440-1496
  • Fax: 248-395-3370
Mailing address:
  • Phone: 248-440-1496
  • Fax: 248-395-3370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE OSGOOD
Title or Position: DIRECTOR OF HIMS
Credential:
Phone: 248-440-1513