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General NPI Number Information
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NPI Number | 1710471115
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Entity Type | Organization
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Legal Business Name | SPRINGWELL ADULT SERVICES PLLC
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Dates
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Enumeration Date | 06/19/2018
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Last Update Date | 06/19/2018
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Provider Practice Location Address
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Address Line | 21122 INDIAN ST
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3579
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Country | US
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Telephone | 248-252-7050
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Fax |
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Provider Business Mailing Address
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Address Line | 23469 RANCH HILL DR W
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3187
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Country | US
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Telephone | 248-252-7050
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | STORMEY DENISE JACKSON
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Credential | LLMSW
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Telephone | 248-252-7050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State | MI
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