=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891917415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RESIDENT ADVANCEMENT INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 05/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 S LEROY STREET
-----------------------------------------------------
City | FENTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-750-0382
-----------------------------------------------------
Fax | 810-750-6712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 S LEROY STREET PO BOX 555
-----------------------------------------------------
City | FENTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | ROCHELLE MOLYNEAUX
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 810-750-0382
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | AS250010859
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | AS760014821
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | AS250010959
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | AS760013141
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | AS250263541
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | AS440284123
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | AS760091948
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | AS250285695
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | AS250010823
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #10
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | AS250010923
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #11
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | AS440284111
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #12
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | AS730263806
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #13
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | AS250264516
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #14
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | AS730071758
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #15
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number | AS250077905
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------