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General NPI Number Information
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NPI Number | 1992903942
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Entity Type | Organization
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Legal Business Name | PASSAGES COMMUNITY SERVICES
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 1220 PALMER ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-2053
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Country | US
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Telephone | 734-454-3691
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Fax | 734-737-9104
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Provider Business Mailing Address
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Address Line | PO BOX 6387
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City | PLYMOUTH
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State | MI
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Zip | 48170-8487
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Country | US
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Telephone | 734-454-3691
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Fax | 734-737-9104
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. MARLENE BOWLING
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Credential |
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Telephone | 734-454-3691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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