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NPI Code Detail

MEDICARE: BENTON'S ABSOLUTE CARE

MEDICARE: BENTON'S ABSOLUTE CARE
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
1320900000XIntellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityAS820289178MI

General Provider Information

NPI Number : 1295127413
Entity Type Code : Organization
Provider Name (Legal Business Name) : BENTON'S ABSOLUTE CARE
Provider Business Mailing Address
First Line : 669 VIRGINIA PARK ST
Second Line :
City : DETROIT
State : MI
Zip : 48202-2011
Country : US
Telephone Number : 313-588-0180
Fax Number :
Provider Business Practice Location Address
First Line : 669 VIRGINIA PARK ST
Second Line :
City : DETROIT
State : MI
Zip : 48202-2011
Country : US
Telephone Number : 313-588-0180
Fax Number :
Authorized Official
Title or Position : CEO
Name : DAISY BENTON
Credential :
Telephone Number : 313-588-0180
Provider Enumeration Date : 02/25/2015
Last Update Date : 02/25/2015

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Directions to “BENTON'S ABSOLUTE CARE ” Practice Location

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