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General NPI Number Information
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NPI Number | 1679873798
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Entity Type | Organization
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Legal Business Name | NORTHWEST DRUG REHABILITATION INC
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Dates
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Enumeration Date | 10/22/2010
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Last Update Date | 10/22/2010
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Provider Practice Location Address
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Address Line | 9600 DEXTER AVE
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City | DETROIT
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State | MI
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Zip | 48206-1816
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Country | US
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Telephone | 313-894-7881
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Fax | 313-894-6312
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Provider Business Mailing Address
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Address Line | 9600 DEXTER AVE
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City | DETROIT
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State | MI
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Zip | 48206-1816
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Country | US
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Telephone | 313-894-7881
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Fax | 313-894-6312
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Authorized Official
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Title or Position | MEDICAL BILLING SPECIALIST
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Name | NATASHA PURRY
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Credential |
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Telephone | 248-739-6343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 4301045243
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License Number State | MI
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