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General NPI Number Information
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NPI Number | 1922744879
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Entity Type | Organization
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Legal Business Name | ISS PC URGENT CARE OHH
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Dates
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Enumeration Date | 05/12/2022
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 19953 CONANT ST
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City | DETROIT
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State | MI
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Zip | 48234-1334
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Country | US
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Telephone | 313-948-8630
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Fax |
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Provider Business Mailing Address
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Address Line | 19953 CONANT ST
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City | DETROIT
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State | MI
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Zip | 48234-1334
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARVIN ARNOLD
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Credential |
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Telephone | 313-948-8630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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