Healthcare Provider Details

I. General information

NPI: 1669833455
Provider Name (Legal Business Name): TAYLOR SPECIAL CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23800 W 10 MILE RD SUITE 210
SOUTHFIELD MI
48033-3176
US

IV. Provider business mailing address

23800 W 10 MILE RD SUITE 210
SOUTHFIELD MI
48033-3176
US

V. Phone/Fax

Practice location:
  • Phone: 248-350-0357
  • Fax:
Mailing address:
  • Phone: 248-350-0357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberAS630313908
License Number StateMI

VIII. Authorized Official

Name: SHERMAN TAYLOR
Title or Position: CEO
Credential:
Phone: 248-350-0357