=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467732263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVOCATES FOR SELF DETERMINATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2011
-----------------------------------------------------
Last Update Date | 08/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 237 N OLD WOODWARD AVE BUILDING A, SUITE 5
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48009-5305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-723-7152
-----------------------------------------------------
Fax | 248-723-7162
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 237 N OLD WOODWARD AVE BUILDING A, SUITE 5
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48009-5305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-723-7152
-----------------------------------------------------
Fax | 248-723-7162
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MS. JANET A PATTERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-723-7152
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------