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General NPI Number Information
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NPI Number | 1649706284
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Entity Type | Organization
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Legal Business Name | SUPPORTIVE ALTERNATIVE LIVING
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 425 W HURON ST SUITE #130
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City | MILFORD
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State | MI
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Zip | 48381-2242
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Country | US
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Telephone | 248-685-2639
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Fax | 248-685-7524
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Provider Business Mailing Address
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Address Line | 425 W HURON ST SUITE #130
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City | MILFORD
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State | MI
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Zip | 48381-2242
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Country | US
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Telephone | 248-685-2639
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Fax | 248-685-7524
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PATRICIA H.F PETERS
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Credential |
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Telephone | 248-685-2639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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