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General NPI Number Information
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NPI Number | 1508623976
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Entity Type | Organization
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Legal Business Name | PASSENGER INC
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 2697 CANIFF ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-3032
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Country | US
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Telephone | 313-288-0062
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Fax |
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Provider Business Mailing Address
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Address Line | 2176 TROWBRIDGE ST
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City | HAMTRAMCK
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State | MI
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Zip | 48212-4403
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Country | US
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Telephone | 313-671-3536
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHRISTOPHER TAIT
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Credential | CPRC
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Telephone | 313-671-3536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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