Healthcare Provider Details

I. General information

NPI: 1831658541
Provider Name (Legal Business Name): PRESERVE INDEPENDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11884 E 10 MILE RD
WARREN MI
48089-3901
US

IV. Provider business mailing address

11884 E 10 MILE RD
WARREN MI
48089-3901
US

V. Phone/Fax

Practice location:
  • Phone: 586-872-5759
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE JONES
Title or Position: CEO
Credential:
Phone: 586-872-5759