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General NPI Number Information
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NPI Number | 1720891914
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Entity Type | Organization
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Legal Business Name | LIBERTY HOUSE OUTPATIENT LLC
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 28345 BECK RD STE 203
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City | WIXOM
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State | MI
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Zip | 48393-4737
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Country | US
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Telephone | 810-208-0266
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Fax | 810-936-8228
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Provider Business Mailing Address
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Address Line | 28345 BECK RD STE 203
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City | WIXOM
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State | MI
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Zip | 48393-4737
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Country | US
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Telephone | 248-290-9800
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Fax | 248-290-9805
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Authorized Official
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Title or Position | CEO / OWNER
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Name | DR. SUSAN ABED
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Credential | DDS-MS
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Telephone | 248-255-6268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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