Healthcare Provider Details

I. General information

NPI: 1306691647
Provider Name (Legal Business Name): TOTAL YOUTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26261 EVERGREEN RD STE 280
SOUTHFIELD MI
48076-7507
US

IV. Provider business mailing address

26261 EVERGREEN RD STE 280
SOUTHFIELD MI
48076-7507
US

V. Phone/Fax

Practice location:
  • Phone: 313-326-3550
  • Fax: 248-358-4193
Mailing address:
  • Phone: 313-326-3550
  • Fax: 248-358-4193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT GILBERT MURDOCK JR.
Title or Position: DIRECTOR
Credential:
Phone: 313-326-3550