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General NPI Number Information
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NPI Number | 1003348145
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Entity Type | Organization
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Legal Business Name | REALITY RESPONSE LLC
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 2455 W GRAND ST
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City | DETROIT
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State | MI
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Zip | 48238-3445
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Country | US
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Telephone | 313-365-7162
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Fax |
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Provider Business Mailing Address
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Address Line | 1961 LONGFELLOW ST
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City | DETROIT
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State | MI
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Zip | 48206-2051
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Country | US
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Telephone | 313-465-2125
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHADONA LANG
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Credential |
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Telephone | 313-465-2125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | AS820316567
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License Number State | MI
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