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General NPI Number Information
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NPI Number | 1275970709
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Entity Type | Organization
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Legal Business Name | MCKENARLD TREATMENT CENTER, IN.
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 24801 5 MILE RD SUITE 19
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City | REDFORD
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State | MI
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Zip | 48239-3655
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Country | US
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Telephone | 313-532-4604
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Fax | 313-532-4608
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Provider Business Mailing Address
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Address Line | 24801 5 MILE RD SUITE 19
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City | REDFORD
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State | MI
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Zip | 48239-3655
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Country | US
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Telephone | 313-532-4604
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Fax | 313-532-4608
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. BERNARD IKE ONWUEMELIE
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Credential | LMSW, CAADC
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Telephone | 313-532-4604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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