MEDICARE: BCA OF DETROIT, 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	261QM1300X	Multi-Specialty Clinic/Center
2	283Q00000X	Psychiatric Hospital	L411642	MI

General Provider Information

NPI Number	:	1699926113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BCA OF DETROIT, LLC

Provider Business Mailing Address
First Line	:	4020 ASPEN GROVE DR STE 900
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-3134
Country	:	US
Telephone Number	:	615-861-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	15000 GRATIOT AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-1973
Country	:	US
Telephone Number	:	313-245-0600
Fax Number	:	313-245-0650

Authorized Official
Title or Position	:	VICE PRESIDENT & SECRETARY
Name	:	BRIAN P. FARLEY
Credential	:
Telephone Number	:	615-861-6000

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	01/20/2026

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