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General NPI Number Information
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NPI Number | 1699201947
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Entity Type | Organization
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Legal Business Name | MICHIGAN SHARE CORPORATION
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 05/05/2017
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Provider Practice Location Address
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Address Line | 22022 OCONNOR ST
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-2043
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Country | US
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Telephone | 586-350-0675
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Fax | 586-362-8334
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Provider Business Mailing Address
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Address Line | PO BOX 404
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-0404
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Country | US
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Telephone | 586-350-0675
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Fax | 586-362-8334
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Authorized Official
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Title or Position | PROVIDER
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Name | ADA MCMILLAN
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Credential |
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Telephone | 586-453-8676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | AS500011897
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | AS500011871
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | AS500011889
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License Number State | MI
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