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General NPI Number Information
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NPI Number | 1245189307
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Entity Type | Individual
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Provider Name | ANTOINE DANIELLE GREENM
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Gender | Male
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Dates
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Enumeration Date | 01/22/2026
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 19506 PATTON ST
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City | DETROIT
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State | MI
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Zip | 48219-2053
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Country | US
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Telephone | 313-516-4176
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Fax |
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Provider Business Mailing Address
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Address Line | 35775 SUSSEX CT
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City | ROMULUS
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State | MI
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Zip | 48174-6335
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Country | US
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Telephone | 313-995-6238
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State | MI
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