=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831480847
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALTERNATIVE HEALTH AND WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2011
-----------------------------------------------------
Last Update Date | 04/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1004 E 7 MILE RD
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48203-2162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-893-2900
-----------------------------------------------------
Fax | 313-893-2902
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1004 E 7 MILE RD
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48203-2162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-893-2900
-----------------------------------------------------
Fax | 313-893-2902
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. PAMELA ANITA TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 313-407-4842
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------