=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245589431
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPLI-HEALTH TECHNOLOGIES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2012
-----------------------------------------------------
Last Update Date | 09/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32999 W 14 MILE RD
-----------------------------------------------------
City | FARMINGTON HILLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48334-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-432-7962
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 47922
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48237-5622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-569-7775
-----------------------------------------------------
Fax | 248-552-1329
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DEE COLLINS
-----------------------------------------------------
Credential | MHSA
-----------------------------------------------------
Telephone | 248-569-7775
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311500000X
-----------------------------------------------------
Taxonomy Name | Alzheimer Center (Dementia Center)
-----------------------------------------------------
License Number | AS630316594
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | AS630316594
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------