1447445358 NPI number — EARLY SOLUTIONS CLINIC

Table of content: (NPI 1447445358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447445358 NPI number — EARLY SOLUTIONS CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EARLY SOLUTIONS CLINIC
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:
1447445358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2333 S. CENTER ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-600-1400
Provider Business Mailing Address Fax Number:
810-600-1403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8650 W GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48116-2327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-534-1220
Provider Business Practice Location Address Fax Number:
810-534-1203
Provider Enumeration Date:
09/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SANTOS
Authorized Official First Name:
JULIET
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
810-600-1400

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  4704224985 , 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)