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General NPI Number Information
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NPI Number | 1356869572
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Entity Type | Organization
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Legal Business Name | AMERICA RECOVERY CENTER, PLLC
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 09/07/2017
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Provider Practice Location Address
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Address Line | 20217 ANN ARBOR TRL
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-2692
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Country | US
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Telephone | 313-395-3444
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Fax | 313-395-3222
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Provider Business Mailing Address
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Address Line | 6867 SNOW APPLE DR
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City | CLARKSTON
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State | MI
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Zip | 48346-1635
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Country | US
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Telephone | 248-820-1712
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | OLIVIA PASS
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Credential |
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Telephone | 248-820-1712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 4301055667
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License Number State | MI
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