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General NPI Number Information
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NPI Number | 1306098801
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Entity Type | Organization
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Legal Business Name | PREMIER SERVICES OF MICHIGAN, LLC
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 02/10/2024
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Provider Practice Location Address
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Address Line | 1400 E 12 MILE RD
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City | MADISON HEIGHTS
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State | MI
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Zip | 48071-2651
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Country | US
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Telephone | 248-547-2223
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Fax | 800-377-9518
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Provider Business Mailing Address
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Address Line | PO BOX 220
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City | SULLIVAN
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State | MO
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Zip | 63080-0220
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Country | US
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Telephone | 573-860-2273
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Fax |
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Authorized Official
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Title or Position | VP REVENUE CYCLE MGMT
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Name | CINDY GAITHER
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Credential |
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Telephone | 602-248-8886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State | MI
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