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General NPI Number Information
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NPI Number | 1124873948
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Entity Type | Organization
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Legal Business Name | ACCOLADE HEALTH LLC
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 12866 FORT ST
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City | SOUTHGATE
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State | MI
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Zip | 48195-1060
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Country | US
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Telephone | 734-720-7920
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Fax |
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Provider Business Mailing Address
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Address Line | 20831 RIDGEMONT RD
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City | HARPER WOODS
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State | MI
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Zip | 48225-1137
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Country | US
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Telephone | 734-720-7920
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | INGRID NICOLE LEWIS
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Credential |
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Telephone | 313-930-0258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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