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General NPI Number Information
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NPI Number | 1568866937
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Entity Type | Organization
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Legal Business Name | BEGINNING OF INDEPENDENCE GROUP LLC
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 49 MACOMB PL SUITE 47
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-5675
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Country | US
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Telephone | 586-604-6766
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Fax |
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Provider Business Mailing Address
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Address Line | 49 MACOMB PLACE SUITE 47
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City | MT. CLEMENS
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State | MI
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Zip | 48043
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Country | US
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Telephone | 586-604-6766
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ROY DEMELE BURTON
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Credential |
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Telephone | 586-604-6766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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