Healthcare Provider Details

I. General information

NPI: 1174767404
Provider Name (Legal Business Name): UNIVERSAL-MICHIGAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 JOHN R RD
TROY MI
48083-2512
US

IV. Provider business mailing address

15-17 MICROLAB ROAD SUITE 101
LIVINGSTON NJ
07039-1623
US

V. Phone/Fax

Practice location:
  • Phone: 248-680-0080
  • Fax: 248-680-1472
Mailing address:
  • Phone: 973-992-8181
  • Fax: 973-992-9797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ADAM STEINBERG
Title or Position: PRESIDENT
Credential:
Phone: 973-992-8181