MEDICARE: SELF HELP ADDICTION REHABILIATION

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	324500000X	Substance Abuse Rehabilitation Facility	6401012143	MI

General Provider Information

NPI Number	:	1376840181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELF HELP ADDICTION REHABILIATION

Provider Business Mailing Address
First Line	:	16633 HUBBELL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-4524
Country	:	US
Telephone Number	:	313-836-1633
Fax Number	:

Provider Business Practice Location Address
First Line	:	4216 MCDOUGALL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-1520
Country	:	US
Telephone Number	:	313-923-6300
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MS. JOYCE ELAINE SAVAGE
Credential	:	M.S, L.L.P.C.
Telephone Number	:	313-923-6300

Provider Enumeration Date	:	02/15/2011
Last Update Date	:	02/15/2011

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