=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487195012
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEXTS CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2017
-----------------------------------------------------
Last Update Date | 03/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26400 LAHSER RD SUITE 345
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48033-2604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-419-4253
-----------------------------------------------------
Fax | 248-419-2134
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26400 LAHSER RD SUITE 345
-----------------------------------------------------
City | SOUTHFIELD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48033-2604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-419-4253
-----------------------------------------------------
Fax | 248-419-2134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WODROW HALL
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 248-419-4253
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 405300000X
-----------------------------------------------------
Taxonomy Name | Prevention Professional
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------