MEDICARE: STABLE WAY LLC

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1154976751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STABLE WAY LLC

Provider Business Mailing Address
First Line	:	13072 ARMSTRONG RD
Second Line	:
City	:	SOUTH ROCKWOOD
State	:	MI
Zip	:	48179-9744
Country	:	US
Telephone Number	:	734-931-6004
Fax Number	:

Provider Business Practice Location Address
First Line	:	13072 ARMSTRONG RD
Second Line	:
City	:	SOUTH ROCKWOOD
State	:	MI
Zip	:	48179-9744
Country	:	US
Telephone Number	:	734-931-6004
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AMY WERTENBERGER
Credential	:	LPC
Telephone Number	:	734-931-6004

Provider Enumeration Date	:	08/09/2019
Last Update Date	:	01/28/2020

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