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General NPI Number Information
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NPI Number | 1306173828
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Entity Type | Organization
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Legal Business Name | B.C. DAVIS INC.
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Dates
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Enumeration Date | 11/04/2009
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Last Update Date | 11/04/2009
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Provider Practice Location Address
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Address Line | 30040 GRANDVIEW
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City | INKSTER
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State | MI
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Zip | 48141
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Country | US
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Telephone | 734-722-5056
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Fax | 734-727-0903
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Provider Business Mailing Address
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Address Line | 30040 GRANDVIEW ST
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City | INKSTER
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State | MI
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Zip | 48141-1014
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Country | US
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Telephone | 734-722-5056
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Fax | 734-727-0903
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | MRS. CHERYL ANNE DAVIS
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Credential |
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Telephone | 313-220-4577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | AS8202283668
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License Number State | MI
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