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General NPI Number Information
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NPI Number | 1609689488
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Entity Type | Organization
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Legal Business Name | WAYNE COUNTY ASSOCIATES LLC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 18900 EUREKA RD
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City | SOUTHGATE
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State | MI
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Zip | 48195-2985
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Country | US
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Telephone | 734-624-3467
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Fax |
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Provider Business Mailing Address
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Address Line | 18900 EUREKA RD
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City | SOUTHGATE
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State | MI
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Zip | 48195-2985
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Country | US
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Telephone | 734-624-3467
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHALLU BHANOT
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Credential |
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Telephone | 734-624-3467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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