1336279272 NPI number — DIMENSIONS THERAPEUTIC SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336279272 NPI number — DIMENSIONS THERAPEUTIC SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIMENSIONS THERAPEUTIC SERVICES
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:
DI MENSIONS MATERNALINFANT SUPPORT
Provider Other Organization Name Type Code:
5
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:
1336279272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21700 GREENFIELD
Provider Second Line Business Mailing Address:
SUITE277
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-968-2600
Provider Business Mailing Address Fax Number:
248-968-2626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21700 GREENFIELD RD
Provider Second Line Business Practice Location Address:
SUITE277
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48237-2581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-968-2600
Provider Business Practice Location Address Fax Number:
248-968-2626
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PASCALL
Authorized Official First Name:
JOYE
Authorized Official Middle Name:
MYREA
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
248-968-2600

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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