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General NPI Number Information
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NPI Number | 1154691483
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Entity Type | Organization
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Legal Business Name | CVM SERVICES
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Dates
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Enumeration Date | 01/03/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 5555 CONNER ST STE 3096
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City | DETROIT
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State | MI
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Zip | 48213-3817
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Country | US
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Telephone | 313-574-0237
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 CHICAGO BLVD
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City | DETROIT
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State | MI
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Zip | 48202-1419
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Country | US
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Telephone | 614-216-8980
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | TEREZ E EDMONDS
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Credential |
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Telephone | 614-216-8980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801088243
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License Number State | MI
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