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General NPI Number Information
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NPI Number | 1003485830
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Entity Type | Organization
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Legal Business Name | PACE SOUTHEAST MICHIGAN
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Dates
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Enumeration Date | 06/24/2021
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 17401 E 10 MILE RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-1256
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Country | US
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Telephone | 855-445-4554
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Fax |
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Provider Business Mailing Address
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Address Line | 21700 NORTHWESTERN HWY
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4906
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Country | US
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Telephone | 855-445-4554
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | BRYAN DOVICHI
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Credential |
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Telephone | 313-269-7744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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