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General NPI Number Information
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NPI Number | 1053722280
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Entity Type | Organization
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Legal Business Name | EAGLE ADVANCEMENT INSTITUTE
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Dates
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Enumeration Date | 05/09/2014
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 7091 ORCHARD LAKE RD SUITE 200
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3654
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Country | US
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Telephone | 248-562-7284
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Fax | 248-707-1081
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Provider Business Mailing Address
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Address Line | 7091 ORCHARD LAKE RD SUITE 200
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-3654
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Country | US
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Telephone | 248-562-7284
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Fax | 248-707-1081
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JAMES WILLIAM CARPENTER
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Credential |
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Telephone | 248-562-7284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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License Number | SA0631360
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | SA0631360
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | L2527661
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License Number State | MI
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