Healthcare Provider Details

I. General information

NPI: 1053722280
Provider Name (Legal Business Name): EAGLE ADVANCEMENT INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7091 ORCHARD LAKE RD SUITE 200
WEST BLOOMFIELD MI
48322-3654
US

IV. Provider business mailing address

7091 ORCHARD LAKE RD SUITE 200
WEST BLOOMFIELD MI
48322-3654
US

V. Phone/Fax

Practice location:
  • Phone: 248-562-7284
  • Fax: 248-707-1081
Mailing address:
  • Phone: 248-562-7284
  • Fax: 248-707-1081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberL2527661
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License NumberSA0631360
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberSA0631360
License Number StateMI

VIII. Authorized Official

Name: MR. JAMES WILLIAM CARPENTER
Title or Position: DIRECTOR
Credential:
Phone: 248-562-7284