Healthcare Provider Details

I. General information

NPI: 1801240734
Provider Name (Legal Business Name): SPECIAL PRIORITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27170 DEQUINDRE RD
WARREN MI
48092-3537
US

IV. Provider business mailing address

27170 DEQUINDRE RD
WARREN MI
48092-3537
US

V. Phone/Fax

Practice location:
  • Phone: 586-558-8978
  • Fax: 586-558-8979
Mailing address:
  • Phone: 586-359-5903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. RONDY D GOINS II
Title or Position: OWNER
Credential:
Phone: 586-359-5903