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NPI Code Detail

MEDICARE: CHERRY STREAT HEALTH SERVICES

MEDICARE: CHERRY STREAT HEALTH SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation Facility822051MI

General Provider Information

NPI Number : 1003180902
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHERRY STREAT HEALTH SERVICES
Provider Business Mailing Address
First Line : 11105 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48214-3317
Country : US
Telephone Number : 313-822-4060
Fax Number : 313-822-1130
Provider Business Practice Location Address
First Line : 11105 E JEFFERSON AVE
Second Line :
City : DETROIT
State : MI
Zip : 48214-3317
Country : US
Telephone Number : 313-822-4060
Fax Number : 313-822-1130
Authorized Official
Title or Position : CLINICAL SUPERVISOR
Name : MR. AVERY E. BROWN JR.
Credential : MA, LPC, CAAC, ICAAD
Telephone Number : 313-822-4060
Provider Enumeration Date : 02/24/2012
Last Update Date : 02/24/2012

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Directions to “CHERRY STREAT HEALTH SERVICES ” Practice Location

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