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General NPI Number Information
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NPI Number | 1124491170
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Entity Type | Organization
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Legal Business Name | INSTITUTE OF SUPPORTIVE SERVICES, INC.
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 12400 E 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48205-2155
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Country | US
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Telephone | 313-948-8630
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Fax | 313-345-3755
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Provider Business Mailing Address
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Address Line | 12400 E 7 MILE RD
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City | DETROIT
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State | MI
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Zip | 48205-2155
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Country | US
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Telephone | 313-948-8630
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Fax | 313-345-3755
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. MARVIN ARNOLD
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Credential | MS/P, CCS, SST, CADC
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Telephone | 313-948-8630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State | MI
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