Healthcare Provider Details

I. General information

NPI: 1770829996
Provider Name (Legal Business Name): VHCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2012
Last Update Date: 12/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25140 LAHSER RD STE 203A
SOUTHFIELD MI
48033-2753
US

IV. Provider business mailing address

30625 NADORA ST
SOUTHFIELD MI
48076-7712
US

V. Phone/Fax

Practice location:
  • Phone: 248-252-8806
  • Fax:
Mailing address:
  • Phone: 248-252-8806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number6801083977
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number6801083977
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6801083977
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number6801083977
License Number StateMI

VIII. Authorized Official

Name: MS. DEBRA JOYCE MARTIN
Title or Position: OWNER
Credential: LMSW
Phone: 248-252-8806