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General NPI Number Information
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NPI Number | 1447602040
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Entity Type | Organization
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Legal Business Name | INTEGRATED SOLUTION LLC
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Dates
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Enumeration Date | 07/07/2016
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 24791 PARKSIDE ST. APT. 206
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City | HARRISON TOWNSHIP
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State | MI
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Zip | 48045
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Country | US
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Telephone | 586-846-6759
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Fax |
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Provider Business Mailing Address
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Address Line | 18441 SUSSEX
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City | DETROIT
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State | MI
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Zip | 48235
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Country | US
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Telephone | 586-846-6759
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. GLYNN MERRIEWETHER
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Credential |
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Telephone | 586-846-6759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801085567
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License Number State | MI
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