Healthcare Provider Details

I. General information

NPI: 1699135103
Provider Name (Legal Business Name): ALTERNATIVE ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23600 HARPER AVE SUITE 101
SAINT CLAIR SHORES MI
48080-1445
US

IV. Provider business mailing address

23600 HARPER AVE SUITE 101
SAINT CLAIR SHORES MI
48080-1445
US

V. Phone/Fax

Practice location:
  • Phone: 586-200-5606
  • Fax: 586-200-5608
Mailing address:
  • Phone: 586-200-5606
  • Fax: 586-200-5608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801090472
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301016094
License Number StateMI

VIII. Authorized Official

Name: BOBBIE CHRISTIAN
Title or Position: PRESIDENT
Credential:
Phone: 586-200-5606