1366727711 NPI number — FAMILY'S R US

Table of content: (NPI 1366727711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366727711 NPI number — FAMILY'S R US

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY'S R US
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366727711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2785 E GRAND BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48211-2003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-623-1555
Provider Business Mailing Address Fax Number:
313-872-7832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2785 E GRAND BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48211-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-623-1555
Provider Business Practice Location Address Fax Number:
313-872-7832
Provider Enumeration Date:
10/17/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CLAYTON
Authorized Official First Name:
CARYN
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
REGISTERED NURSE/OWNER
Authorized Official Telephone Number:
313-728-3736

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  4704271302 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)