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General NPI Number Information
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NPI Number | 1215130554
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Entity Type | Organization
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Legal Business Name | REDWOOD
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5425 WHIPPLE LAKE RD
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City | CLARKSTON
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State | MI
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Zip | 48348-3058
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Country | US
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Telephone | 248-394-1836
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Fax | 248-620-6061
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Provider Business Mailing Address
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Address Line | 3280 TRILLIUM LN
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City | OXFORD
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State | MI
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Zip | 48371-5528
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Country | US
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Telephone | 248-625-1280
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Fax | 248-620-6061
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | REETA J SMITH
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Credential |
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Telephone | 248-625-1280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | MI
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