Healthcare Provider Details

I. General information

NPI: 1588750087
Provider Name (Legal Business Name): MARABLE SPECIALIZED CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 S SCHUMAN ST
WESTLAND MI
48186-4592
US

IV. Provider business mailing address

PO BOX 34233
DETROIT MI
48234-0233
US

V. Phone/Fax

Practice location:
  • Phone: 734-326-7642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateMI

VIII. Authorized Official

Name: ANDRE MARABLE
Title or Position: PROVIDER
Credential:
Phone: 313-289-9730