=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447445358
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EARLY SOLUTIONS CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2007
-----------------------------------------------------
Last Update Date | 09/13/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8650 W GRAND RIVER AVE
-----------------------------------------------------
City | BRIGHTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48116-2327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-534-1220
-----------------------------------------------------
Fax | 810-534-1203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2333 S. CENTER ROAD
-----------------------------------------------------
City | BURTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-600-1400
-----------------------------------------------------
Fax | 810-600-1403
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | JULIET A SANTOS
-----------------------------------------------------
Credential | ANP
-----------------------------------------------------
Telephone | 810-600-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number | 4704224985
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------