MEDICARE: ETHOS BEHAVIORAL HEALTH

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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1215419064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETHOS BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	25900 GREENFIELD RD STE 100
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-1297
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	32047 VEGAS DR
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-6175
Country	:	US
Telephone Number	:	833-384-6724
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	ERICA CALDWELL
Credential	:
Telephone Number	:	833-384-6724

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	02/22/2023

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Directions to “ETHOS BEHAVIORAL HEALTH ” Practice Location

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