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General NPI Number Information
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NPI Number | 1780452565
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Entity Type | Organization
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Legal Business Name | RUSHTON RECOVERY LLC
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 9600 N RUSHTON RD
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City | SOUTH LYON
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State | MI
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Zip | 48178-8849
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Country | US
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Telephone | 734-604-0411
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Fax |
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Provider Business Mailing Address
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Address Line | 2960 WALNUT RIDGE DR
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City | ANN ARBOR
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State | MI
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Zip | 48103-2189
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Country | US
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Telephone | 734-604-0411
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRANDEE WISEMAN
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Credential |
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Telephone | 734-604-0411
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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 |
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License Number State |
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