Healthcare Provider Details

I. General information

NPI: 1841343670
Provider Name (Legal Business Name): COMMUNITY RESIDENCE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1851 WASHTENAW RD
YPSILANTI MI
48197-1702
US

IV. Provider business mailing address

1851 WASHTENAW RD
YPSILANTI MI
48197-1702
US

V. Phone/Fax

Practice location:
  • Phone: 734-482-3300
  • Fax: 734-482-3894
Mailing address:
  • Phone: 734-482-3300
  • Fax: 734-482-3894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateMI

VIII. Authorized Official

Name: KATHERINE M. GRANT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 734-482-3300