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General NPI Number Information
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NPI Number | 1528392867
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Entity Type | Organization
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Legal Business Name | ANDERSON HOUSE LLC
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Dates
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Enumeration Date | 09/18/2009
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 28366 FRANKLIN RIVER DR APT 106
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City | SOUTHFIELD
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State | MI
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Zip | 48034-5409
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Country | US
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Telephone | 313-205-0411
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Fax | 248-996-8478
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Provider Business Mailing Address
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Address Line | 28366 FRANKLIN RIVER DR APT 106
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City | SOUTHFIELD
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State | MI
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Zip | 48034-5409
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Country | US
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Telephone | 313-205-0411
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Fax | 248-996-8478
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Authorized Official
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Title or Position | CEO
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Name | MR. EDWARD MANUEL ANDERSON JR.
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Credential | CAC CPC
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Telephone | 313-205-0411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 822780
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License Number State | MI
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