Healthcare Provider Details

I. General information

NPI: 1194124842
Provider Name (Legal Business Name): URBAN THERAPEUTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30253 AUSTIN DR
WARREN MI
48092-1896
US

IV. Provider business mailing address

30253 AUSTIN DR
WARREN MI
48092-1896
US

V. Phone/Fax

Practice location:
  • Phone: 586-770-5566
  • Fax:
Mailing address:
  • Phone: 586-770-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JULIAN MICHAEL URBAN
Title or Position: PRESIDENT
Credential: COTA/L
Phone: 586-770-5566