=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932243953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EARLY SOLUTIONS CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14640 PARDEE RD
-----------------------------------------------------
City | TAYLOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48180-4739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-759-1100
-----------------------------------------------------
Fax | 734-759-1102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | G-2333 S. CENTER ROAD
-----------------------------------------------------
City | BURTON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-600-1400
-----------------------------------------------------
Fax | 810-600-1403
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CEO
-----------------------------------------------------
Name | MRS. JULIET A. SANTOS
-----------------------------------------------------
Credential | NURSE PRACTITIONER
-----------------------------------------------------
Telephone | 810-240-8800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number | 4704224985
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------