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General NPI Number Information
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NPI Number | 1154717247
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Entity Type | Organization
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Legal Business Name | OUR PLACE DROP INC
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Dates
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Enumeration Date | 04/15/2015
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 12285 DIXIE SUITE 100
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City | REDFORD
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State | MI
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Zip | 48239-2491
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Country | US
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Telephone | 313-543-3393
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Fax | 313-543-3395
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Provider Business Mailing Address
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Address Line | 12285 DIXIE SUITE 100
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City | REDFORD
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State | MI
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Zip | 48239-2491
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Country | US
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Telephone | 313-543-3393
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Fax | 313-543-3395
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | WILLIAM NOWACKI
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Credential | CPSS
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Telephone | 313-543-3393
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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 |
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License Number State | MI
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