Healthcare Provider Details

I. General information

NPI: 1144119033
Provider Name (Legal Business Name): PHREE SPACE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2443 DIAMOND CT
WIXOM MI
48393-4216
US

IV. Provider business mailing address

2443 DIAMOND CT
WIXOM MI
48393-4216
US

V. Phone/Fax

Practice location:
  • Phone: 313-469-4336
  • Fax:
Mailing address:
  • Phone: 313-469-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ESE K REED
Title or Position: FOUNDER
Credential:
Phone: 313-469-4336