1346415858 NPI number — SELECT CARE PLLC

Table of content: (NPI 1346415858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346415858 NPI number — SELECT CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SELECT CARE PLLC
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:
WALTER P REUTHER PSYCHIATRIC HOSPITAL
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:
1346415858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7059 TIMBERVIEW TRAIL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-788-9272
Provider Business Mailing Address Fax Number:
248-788-9272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7059 TIMBERVIEW TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST BLOOMFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48322-3353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-788-9272
Provider Business Practice Location Address Fax Number:
248-788-9272
Provider Enumeration Date:
04/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BROHI
Authorized Official First Name:
SHIREEN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
248-330-2282

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  4301062399 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 281P00000X , with the licence number: 4301062399 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 4301062399 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 283Q00000X , with the licence number: 4301062399 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 310400000X , with the licence number: 4301062399 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X , with the licence number: 4301062399 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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