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NPI Code Detail

MEDICARE: ELMHURST HOME, INC.

MEDICARE: ELMHURST HOME, INC.
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 Facility820202MI

General Provider Information

NPI Number : 1366659906
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELMHURST HOME, INC.
Provider Business Mailing Address
First Line : 12010 LINWOOD ST
Second Line : P. O. BOX 06716
City : DETROIT
State : MI
Zip : 48206-1108
Country : US
Telephone Number : 313-867-1002
Fax Number : 313-867-7776
Provider Business Practice Location Address
First Line : 12010 LINWOOD ST
Second Line :
City : DETROIT
State : MI
Zip : 48206-1108
Country : US
Telephone Number : 313-867-1002
Fax Number : 313-867-7776
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. JOHN CAMPBELL ODEN
Credential :
Telephone Number : 313-867-1002
Provider Enumeration Date : 05/16/2007
Last Update Date : 01/13/2026

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Directions to “ELMHURST HOME, INC. ” Practice Location

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