1366823197 NPI number — ROYAL TREATMENT MENTAL HEALTH SYSTEMS, LLC

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 1366823197 NPI number — ROYAL TREATMENT MENTAL HEALTH SYSTEMS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROYAL TREATMENT MENTAL HEALTH SYSTEMS, LLC
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:
6
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:
1366823197
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 GRISWOLD ST STE 111
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:
48226-3673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-624-7966
Provider Business Mailing Address Fax Number:
313-447-3999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5555 CORNER AVENUE
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:
48213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-624-7966
Provider Business Practice Location Address Fax Number:
313-447-3999
Provider Enumeration Date:
06/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HART
Authorized Official First Name:
GARKYE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
313-624-7966

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  D9312H , 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)





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