Healthcare Provider Details

I. General information

NPI: 1104718170
Provider Name (Legal Business Name): ETHOS BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32047 VEGAS DR
WARREN MI
48093-6175
US

IV. Provider business mailing address

25900 GREENFIELD RD STE 100
OAK PARK MI
48237-1297
US

V. Phone/Fax

Practice location:
  • Phone: 248-690-3422
  • Fax:
Mailing address:
  • Phone: 248-690-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: ERICA CALDWELL
Title or Position: VICE PRESIDENT OF ADMINISTRATION
Credential:
Phone: 248-690-3422