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General NPI Number Information
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NPI Number | 1376944322
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Entity Type | Individual
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Provider Name | KENNETH THOMPSON
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Gender | Male
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 09/09/2014
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Provider Practice Location Address
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Address Line | 708 CORTWRIGHT ST
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City | PONTIAC
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State | MI
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Zip | 48340-2302
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Country | US
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Telephone | 248-481-9927
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Fax | 248-335-6240
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Provider Business Mailing Address
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Address Line | 102 W YALE AVE
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City | PONTIAC
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State | MI
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Zip | 48340-1862
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Country | US
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Telephone | 248-431-5341
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Fax | 248-335-6240
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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Taxonomy #3
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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Taxonomy #4
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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Taxonomy #5
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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Taxonomy #6
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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