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General NPI Number Information
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NPI Number | 1174014500
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Entity Type | Organization
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Legal Business Name | CEIRRA ADULT DAY CENTER
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 16309 HARDEN CIR
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3022
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Country | US
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Telephone | 248-388-8935
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Fax |
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Provider Business Mailing Address
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Address Line | 16309 HARDEN CIR
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JEANNETTE GORDON
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Credential |
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Telephone | 248-388-8935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | MI
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