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General NPI Number Information
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NPI Number | 1720264757
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Entity Type | Organization
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Legal Business Name | MILESTONE SPECIALIZED CARE,INC.
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 01/22/2008
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Provider Practice Location Address
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Address Line | 15388 DIXIE ST.
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City | REDFORD
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State | MI
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Zip | 48239-3637
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Country | US
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Telephone | 313-686-4412
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Fax |
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Provider Business Mailing Address
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Address Line | 15388 DIXIE
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City | REDFORD
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State | MI
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Zip | 48239-3637
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Country | US
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Telephone | 313-686-4412
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MS. JAN MCGHEE
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Credential | B.A.
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Telephone | 313-686-4412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 101YMO8OOX
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License Number State | MI
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