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General NPI Number Information
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NPI Number | 1609135409
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Entity Type | Organization
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Legal Business Name | RASPBERRY MANOR
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 6141 S STATE RD
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City | GOODRICH
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State | MI
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Zip | 48438-8849
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Country | US
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Telephone | 810-636-3900
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Fax | 810-636-3900
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Provider Business Mailing Address
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Address Line | 6141 S STATE RD
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City | GOODRICH
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State | MI
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Zip | 48438-8849
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Country | US
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Telephone | 810-636-3900
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Fax | 810-636-3900
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Authorized Official
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Title or Position | CO OWNER
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Name | MR. CURTIS DALE COUSINEAU
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Credential |
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Telephone | 810-636-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | AF250071517
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License Number State | MI
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