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General NPI Number Information
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NPI Number | 1750833166
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Entity Type | Organization
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Legal Business Name | VISIONS HOUSE
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 182 FARRAND PARK
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City | HIGHLAND PARK
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State | MI
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Zip | 48203-3354
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Country | US
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Telephone | 313-868-2267
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Fax |
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Provider Business Mailing Address
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Address Line | 18426 ROSELAWN ST
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City | DETROIT
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State | MI
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Zip | 48221-2116
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Country | US
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Telephone | 313-460-0343
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Fax | 313-341-2569
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Authorized Official
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Title or Position | DIRECTOR
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Name | KENNETH DAVIS
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Credential | CPRM CPS
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Telephone | 313-460-0343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | SA0823060
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License Number State | MI
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