Healthcare Provider Details

I. General information

NPI: 1992086144
Provider Name (Legal Business Name): PREMIER CARE WARREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 02/10/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23700 VAN DYKE AVE
WARREN MI
48089-1600
US

IV. Provider business mailing address

20205 SORRENTO ST
DETROIT MI
48235-1191
US

V. Phone/Fax

Practice location:
  • Phone: 586-758-6670
  • Fax: 586-758-0243
Mailing address:
  • Phone: 313-585-8389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: CINDY GAITHER
Title or Position: VP REVENUE CYCLE MGMT
Credential:
Phone: 602-248-8886