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General NPI Number Information
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NPI Number | 1265837280
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Entity Type | Organization
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Legal Business Name | SUNSHINE TREATMENT INSTITUTE LLC
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 02/11/2016
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Provider Practice Location Address
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Address Line | 4821 E MCNICHOLS RD
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City | DETROIT
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State | MI
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Zip | 48212-1730
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Country | US
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Telephone | 313-368-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 4821 E MCNICHOLS RD
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City | DETROIT
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State | MI
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Zip | 48212-1730
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Country | US
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Telephone | 313-368-4600
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MARIA R BALLEZA
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Credential |
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Telephone | 313-368-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | SA0822928
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 4301049546
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License Number State | MI
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