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General NPI Number Information
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NPI Number | 1053033043
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Entity Type | Organization
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Legal Business Name | OPTIMUM ADULT DAY SERVICES
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Dates
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Enumeration Date | 09/15/2022
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 25268 5 MILE RD
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City | REDFORD
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State | MI
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Zip | 48239-3702
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Country | US
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Telephone | 313-543-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 4575 WABEEK FOREST DR
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-1782
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHARLES KEROBO
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Credential |
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Telephone | 313-543-3344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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