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General NPI Number Information
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NPI Number | 1669864484
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Entity Type | Organization
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Legal Business Name | CENTRIA HEALTHCARE
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 03/03/2015
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Provider Practice Location Address
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Address Line | 17361 PREST ST
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City | DETROIT
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State | MI
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Zip | 48235-3731
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Country | US
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Telephone | 313-736-8564
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Fax |
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Provider Business Mailing Address
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Address Line | 17361 PREST ST
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City | DETROIT
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State | MI
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Zip | 48235-3731
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Country | US
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Telephone | 313-736-8564
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Fax |
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Authorized Official
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Title or Position | TECHNICIAN
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Name | PAMELA WASHINGTON
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Credential | SOCIAL WORKER
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Telephone | 313-736-8564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 247200000
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License Number State | MI
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