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General NPI Number Information
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NPI Number | 1033635891
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Entity Type | Organization
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Legal Business Name | PACKARD GROUP INC
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Dates
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Enumeration Date | 08/14/2017
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Last Update Date | 08/14/2017
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Provider Practice Location Address
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Address Line | 731 PALLISTER ST
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City | DETROIT
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State | MI
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Zip | 48202-2418
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Country | US
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Telephone | 313-872-7826
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Fax | 313-731-1771
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Provider Business Mailing Address
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Address Line | PO BOX 2066
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City | SOUTHFIELD
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State | MI
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Zip | 48037-2066
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Country | US
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Telephone | 313-350-0744
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Fax | 313-731-1771
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Authorized Official
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Title or Position | PROVIDER
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Name | GLADYS MARIE SLEDGE
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Credential | LMSW
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Telephone | 313-350-4731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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