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General NPI Number Information
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NPI Number | 1720686165
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Entity Type | Organization
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Legal Business Name | CENTIA HEALTH LLC
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Dates
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Enumeration Date | 10/16/2020
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 23802 WINTERGREEN CIR
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City | NOVI
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State | MI
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Zip | 48374-3681
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Country | US
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Telephone | 236-842-4328
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Fax |
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Provider Business Mailing Address
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Address Line | 7 MILLWRIGHT DR
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City | GLEN MILLS
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State | PA
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Zip | 19342-1363
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SOSUNMOLU OPEMEMI SHOYINKA
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Credential |
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Telephone | 917-589-4879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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