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General NPI Number Information
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NPI Number | 1730630062
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Entity Type | Organization
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Legal Business Name | OUR PARENTS ADULT DAY TREATMENT LLC
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 17115 E 9 MILE RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-2552
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Country | US
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Telephone | 586-200-5499
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Fax | 586-200-5115
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Provider Business Mailing Address
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Address Line | 17115 E 9 MILE RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-2552
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Country | US
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Telephone | 586-200-5499
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Fax | 586-200-5115
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. DIANNA L HAWKINS GREATHOUSE
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Credential |
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Telephone | 586-200-5499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | MI
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