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1982460234 NPI number — STREET LIFE RECOVERY PROGRAM

NPI Number: 1982460234
Health Care Provider/Practitioner: STREET LIFE RECOVERY PROGRAM

Information about “1982460234” NPI (STREET LIFE RECOVERY PROGRAM) exists in 1982460234 in HTML format HTML  |  1982460234 in plain Text format TXT  |  1982460234 in PDF (Portable Document Format) PDF  |  1982460234 in an XML format XML  formats.

NPI Number : 1982460234 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1982460234",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "STREET LIFE RECOVERY PROGRAM",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "14703 ALLEN RD STE 104",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTHGATE",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48195-2594",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "734-262-2753",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "14703 ALLEN RD STE 104",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTHGATE",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48195-2594",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "734-496-5599",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/26/2024",
    "LastUpdateDate": "08/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "ROBINSON",
    "AuthorizedOfficialFirstName": "EDWARD",
    "AuthorizedOfficialMiddleName": "IAN",
    "AuthorizedOfficialTitle": "EXECUTIVE DIRECTOR",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PEER SUPPORT",
    "AuthorizedOfficialTelephoneNumber": "734-262-2753",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM0801X",
        "TaxonomyName": "Mental Health Clinic/Center (Including Community Mental Health Center)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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